NPI | 1386218451 |
---|---|
Former Name | TESIA MARIE SMITH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12328) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 30426) |
Enumeration Date | 2021-05-13 |
Last Update Date | 2021-08-03 |