NPI | 1194140244 |
---|---|
Former Name | JORDAN R GALLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 072794) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070020563) |
Enumeration Date | 2014-02-26 |
Last Update Date | 2021-03-31 |