| NPI | 1174829444 |
|---|---|
| Former Name | LAURA MARIE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC PT14777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT021123) |
| 225100000X Physical Therapist (Licence: SC 7303) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2016-11-01 |