| NPI | 1114479672 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 2177) |
| 261Q00000X Clinic/Center (Licence: WI 2177) | |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2023-10-04 |