| NPI | 1144686890 |
|---|---|
| Former Name | JODY JEAN RADLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: IA 00796) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NE 900) |
| 225200000X Physical Therapy Assistant (Licence: KS 14-02204) | |
| Enumeration Date | 2016-01-11 |
| Last Update Date | 2016-01-11 |