| NPI | 1255781001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 4259) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4456) |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2023-03-17 |