| NPI | 1356874515 |
|---|---|
| Former Name | STEPHANIE ROSS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070025323) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-01-31 |