NPI | 1396065579 |
---|---|
Former Name | CHRISTINA DEANN IMGARTEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2010017704) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2007034692) |
Enumeration Date | 2010-06-10 |
Last Update Date | 2013-08-06 |