| NPI | 1205893682 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070005288) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: IL 096000275) |
| 225100000X Physical Therapist (Licence: AZ 30477) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2022-12-16 |