| NPI | 1063865228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030177) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2023-12-12 |