| NPI | 1154746121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: CA 41494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208539) |
| Enumeration Date | 2014-02-27 |
| Last Update Date | 2019-08-02 |