NPI | 1083013718 |
---|---|
Former Name | JENNIFER DEBOER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 11104) |
Additional Taxonomies | 2251S0007X Physical Therapist Sports |
2251X0800X Physical Therapist Orthopedic | |
Enumeration Date | 2014-08-19 |
Last Update Date | 2015-09-15 |