| NPI | 1134165202 |
|---|---|
| Former Name | JENNIFER IRENE JOSE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10177) |
| Additional Taxonomies | 174400000X Specialist (Licence: ME PT2782) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2011-08-30 |