NPI | 1225503154 |
---|---|
Former Name | SHELBY PENDERGRAFT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212293) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27181) |
Enumeration Date | 2018-10-08 |
Last Update Date | 2024-03-22 |