| NPI | 1154807378 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13326) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: 2000032200) | |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2022-08-13 |