| NPI | 1114547122 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: ME PT5405) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MA 21570) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: AZ 31182) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 9947) | |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2020-04-20 |