| NPI | 1235512377 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305203196)  | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 2369)  | 
| 225100000X Physical Therapist (Licence: GA PT004376)  | |
| Enumeration Date | 2015-07-07 | 
| Last Update Date | 2015-07-07 |