| NPI | 1194925768 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 12642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 02829) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2017-01-05 |