| NPI | 1376996157 |
|---|---|
| Former Name | JESSIE RAE MCKANNA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05012860A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT32444) |
| Enumeration Date | 2016-07-18 |
| Last Update Date | 2021-03-31 |