| NPI | 1083140107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0127755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0014530) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2017-05-10 |