| NPI | 1316835929 |
|---|---|
| Former Name | DESIREE KIANNA BRADWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT018348) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2026-09-22 |