| NPI | 1255780300 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26943) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1274512) |
| 225100000X Physical Therapist (Licence: CA 292626) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-05-30 |