| NPI | 1396222519 |
|---|---|
| Former Name | MACKENZIE MEARS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2063) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11200) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2019-06-06 |