| NPI | 1255729901 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11877) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WI 11877) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 1222) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2020-01-25 |