| NPI | 1346088556 |
|---|---|
| Former Name | KIMBERLY PAIGE DECOSTA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 15612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA CP032841T) |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2024-07-29 |