| NPI | 1194417063 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 012115) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: WA 61450689) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-11-04 |