| NPI | 1114521457 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217598) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501019853) |
| Enumeration Date | 2020-11-27 |
| Last Update Date | 2026-04-10 |