| NPI | 1255606836 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: OR 60672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009294) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2022-02-26 |