| NPI | 1265007744 |
|---|---|
| Former Name | JACLYN SIDOW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY PT-008387) |
| 225100000X Physical Therapist (Licence: OH PT019170) | |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2023-02-03 |