| NPI | 1164939104 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT5606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 2261375) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AZ 1187) | |
| 225100000X Physical Therapist (Licence: AZ 30413) | |
| Enumeration Date | 2017-12-29 |
| Last Update Date | 2025-07-31 |