| NPI | 1366423543 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 230500239) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305002390) |
| 2251S0007X Physical Therapist Sports (Licence: VA 2305002390) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2021-11-29 |