| NPI | 1265856504 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018489) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT28952) |
| 225100000X Physical Therapist (Licence: CA PT41085) | |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2016-08-31 |