| NPI | 1174747208 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 2580-24) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 45039) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-11-16 |