| NPI | 1316413511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004688) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WV AT001684) |
| Enumeration Date | 2018-10-16 |
| Last Update Date | 2023-11-06 |