| NPI | 1356687677 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MA 19912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 60050) |
| Enumeration Date | 2012-12-13 |
| Last Update Date | 2015-05-19 |