| NPI | 1356641575 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8622) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2012-06-01 |