| NPI | 1124211941 |
|---|---|
| Former Name | NICOLE J VANDERWIELE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60011687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070015873) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2017-11-17 |