| NPI | 1104039791 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6990) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 6990) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-09 |