| NPI | 1376113605 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052748-01) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-09-05 |