| NPI | 1134647845 |
|---|---|
| Former Name | MICHELLE SUZANNE WANGROW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14545-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 10400509-2401) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2020-11-16 |