| NPI | 1104962364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17421) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MA 17421) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-08-20 |