| NPI | 1154533917 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: ID 4813) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3286) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2025-08-01 |