| NPI | 1376038414 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23630) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01693700) | 
| Enumeration Date | 2018-06-29 | 
| Last Update Date | 2018-06-29 |