| NPI | 1215202692 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16135) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 21856) |
| Enumeration Date | 2012-03-18 |
| Last Update Date | 2020-11-06 |