| NPI | 1295168490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13317) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9363) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: MN 9363) | |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2024-05-01 |