| NPI | 1174356190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 308766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02324500) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00317400) | |
| Enumeration Date | 2024-08-23 |
| Last Update Date | 2025-09-08 |