| NPI | 1255103792 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2021038886) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12861) |
| 225100000X Physical Therapist (Licence: CO PTL.0017545) | |
| Enumeration Date | 2023-10-27 |
| Last Update Date | 2023-10-27 |