| NPI | 1285292862 |
|---|---|
| Former Name | ALICIA BLACKHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 11099512-2401) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2020-08-10 |