| NPI | 1164828299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0101900) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2025-01-22 |