| NPI | 1336614080 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053420-01) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 1642) | |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2025-06-23 |