| NPI | 1205970571 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19928) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104-0000127) |
| 225100000X Physical Therapist (Licence: CT 009116) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2012-07-26 |