NPI | 1386920759 |
---|---|
Former Name | MEGAN LYNNAE VAN ROEKEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1555) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004784) |
225100000X Physical Therapist (Licence: MN 8809) | |
Enumeration Date | 2011-10-28 |
Last Update Date | 2011-12-08 |