| NPI | 1164628152 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT006128) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT006128) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: GA PT006128) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2020-03-27 |