| NPI | 1366634719 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10179) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001409A) | |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2020-08-11 |