| NPI | 1316477516 |
|---|---|
| Former Name | GINA MARIE PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT60743687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60743687) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-03-12 |