| NPI | 1255760930 |
|---|---|
| Former Name | HEATHER MICKEAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11599) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01521000) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2022-11-16 |