| NPI | 1376678383 |
|---|---|
| Former Name | AUDREY ELLEN LIBERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 31410) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1105245) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-10-13 |