| NPI | 1225315070 |
|---|---|
| Former Name | MICHELLE CELESTE THACKWRAY (BONNER) |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 11188) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2016-01-05 |