| NPI | 1356855464 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60839865)  | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL0015250)  | 
| 225100000X Physical Therapist (Licence: IA 093664)  | |
| 225100000X Physical Therapist (Licence: SC PT.9566)  | |
| 225100000X Physical Therapist (Licence: ME PT5353)  | |
| 225100000X Physical Therapist (Licence: WY PT-1936)  | |
| Enumeration Date | 2017-11-28 | 
| Last Update Date | 2021-03-07 |