| NPI | 1104256932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4821) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: AR PTA 2791) |
| Enumeration Date | 2013-11-14 |
| Last Update Date | 2020-09-02 |