| NPI | 1104294008 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21995) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10617) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2015-09-09 |