| NPI | 1194180810 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT.70054960) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WA A1.60047748) |
| Enumeration Date | 2015-12-22 |
| Last Update Date | 2025-11-25 |