| NPI | 1235513789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12072644-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0113073) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2022-03-28 |