| NPI | 1093001836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-04312) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: KS 11-04312) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2020-12-22 |