| NPI | 1154809077 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: VA 2305212178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212178) |
| 225100000X Physical Therapist (Licence: OK 5769) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: VA 2305212178) | |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2023-08-29 |