| NPI | 1104605732 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053130) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023049144) |
| 225100000X Physical Therapist (Licence: KS 1107487) | |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-09-09 |