| NPI | 1285042655 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208715) |
| 225100000X Physical Therapist (Licence: MD 25075) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT004872) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2018-06-13 |