| NPI | 1255713012 |
|---|---|
| Former Name | GINA NICOLE PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: ND 2035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05011748A) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2017-02-09 |