| NPI | 1164187985 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 14719) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TN 3025) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT008356) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2025-03-11 |