| NPI | 1144778234 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1115228) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: TX 1115228) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1115228) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1115228) | |
| Enumeration Date | 2016-09-17 |
| Last Update Date | 2016-09-17 |