| NPI | 1073721213 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 7144) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1950) | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2016-07-23 |