| NPI | 1124025077 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009564) |
| 225100000X Physical Therapist (Licence: UT 3777512401) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-07-11 |