| NPI | 1205025012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9069) |
| 225100000X Physical Therapist (Licence: WY 512) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2011-01-07 |