| NPI | 1184165946 |
|---|---|
| Former Name | REQUEST VIA PRACTITIONER IF APPLICABLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: WA 60717251) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2022-07-21 |