NPI | 1174620611 |
---|---|
Former Name | KELIE JEAN PODRATZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 7809) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 1937) |
Enumeration Date | 2006-09-19 |
Last Update Date | 2018-09-04 |