| NPI | 1104040237 |
|---|---|
| Former Name | AMANDA JAYE BALES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-5431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2007008743) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2025-07-08 |