| NPI | 1275753188 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AL 5255) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 805) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2012-03-15 |