| NPI | 1326240540 |
|---|---|
| Former Name | CANDY M BACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 29632) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10305) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-04-25 |