| NPI | 1336164177 |
|---|---|
| Former Name | ANGELA L GARDNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070013810) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2018-06-07 |