| NPI | 1164934667 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 007156) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: AZ 13381) |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2021-04-13 |