NPI | 1316565658 |
---|---|
Former Name | BREANNA M NEDDEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019753) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-REG-0001140) |
Enumeration Date | 2020-07-13 |
Last Update Date | 2025-09-11 |