| NPI | 1114136157 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT2071) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: GA 2071) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA 75) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-04-20 |