| NPI | 1316327067 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2020023285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06503) |
| 225200000X Physical Therapy Assistant (Licence: KS 14-02859) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2020-08-06 |