| NPI | 1194722728 |
|---|---|
| Former Name | ILISE DEVINE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010344) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3359) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2019-06-27 |