| NPI | 1255987558 |
|---|---|
| Former Name | COURTNEY MARIE WILT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213053) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2022-08-24 |