| NPI | 1104062363 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041704) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006875-1) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2021-03-09 |