| NPI | 1114514999 |
|---|---|
| Former Name | STACEY AUSTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070017140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 16076) |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2025-01-14 |