| NPI | 1063980472 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: TX 1176458) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2021-08-26 |