| NPI | 1114067964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 017083) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: PA PT017083) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2019-04-22 |