| NPI | 1245682764 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2016023768) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05392) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: KS 24-00773) | |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2017-10-12 |