| NPI | 1104416981 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5521) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12518) |
| 225100000X Physical Therapist (Licence: NC P100210E) | |
| 225100000X Physical Therapist (Licence: NH EL05229) | |
| Enumeration Date | 2021-01-25 |
| Last Update Date | 2021-01-25 |