| NPI | 1205269669 |
|---|---|
| Former Name | KRISTINE MARIE GRANACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 01957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.018960) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2013-08-20 |