| NPI | 1356051783 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist Athletic Trainer |
| Additional Taxonomies | 171400000X |
| 225700000X Massage Therapist (Licence: TX MT042244) | |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2023-01-11 |