| NPI | 1104906635 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT1952) |
| 225100000X Physical Therapist (Licence: CO PTL0011581) | |
| 225100000X Physical Therapist (Licence: UT 8161046-2401) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-02-25 |