| NPI | 1205315140 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: VA 2305212301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P18032) |
| 225100000X Physical Therapist (Licence: TX 1304919) | |
| 225100000X Physical Therapist (Licence: SC 9163) | |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2019-03-05 |