| NPI | 1184842072 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070013096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 22966) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096001193) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |