| NPI | 1255539714 |
|---|---|
| Former Name | TARA LOUISE LILLEMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11724) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 23423) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2025-01-03 |