| NPI | 1083697346 |
|---|---|
| Former Name | KRISTINA DIANE PORTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004686) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2024-05-21 |