| NPI | 1114493442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 2251S0007X Physical Therapist, Sports (Licence: NY 0293661) | |
| Enumeration Date | 2018-10-13 |
| Last Update Date | 2018-10-13 |