| NPI | 1104579572 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019739) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05386) |
| 225100000X Physical Therapist (Licence: NM PT-2024-0315) | |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2026-02-22 |