| NPI | 1164965430 |
|---|---|
| Former Name | ANGELA STOUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 8545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA T012547) |
| 225100000X Physical Therapist (Licence: LA 09487R) | |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2023-03-23 |