| NPI | 1346696135 |
|---|---|
| Former Name | MADALYN M VANDER LOOP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070022591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 14439) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2025-01-03 |