| NPI | 1265576920 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070018147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10742024) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IL 096.002994) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2013-01-10 |