| NPI | 1205574175 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MA 23546) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 23546) |
| Enumeration Date | 2022-05-21 |
| Last Update Date | 2024-11-13 |