| NPI | 1225480569 |
|---|---|
| Former Name | STEPHANIE BROOKE HEYDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT33059) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05489) |
| 225100000X Physical Therapist (Licence: MO 2016033281) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-07-10 |