| NPI | 1154714756 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14663) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 1648) |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2024-05-28 |