| NPI | 1063816668 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 26678) |
| Enumeration Date | 2014-10-10 |
| Last Update Date | 2023-03-02 |