| NPI | 1235692781 |
|---|---|
| Former Name | BROOKE DIETSCHE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 15887-24) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2024-12-03 |