| NPI | 1225713589 |
|---|---|
| Former Name | MCKENZE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-033955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 2581) |
| Enumeration Date | 2023-06-15 |
| Last Update Date | 2025-01-31 |