| NPI | 1164589990 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT007355) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MO 2001017942) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-09 |