| NPI | 1396091898 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL FL - AL2814) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA27079) |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2016-10-20 |