| NPI | 1376500124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 1988) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: ID 234) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2011-12-13 |