| NPI | 1225469786 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL 24125) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: GA Pta003156) |
| 225200000X Physical Therapy Assistant (Licence: AL 1552) | |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2014-03-19 |