| NPI | 1104385764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MO 2021033579) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013217A) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2021-09-03 |