| NPI | 1396431243 |
|---|---|
| Former Name | KYLIE JACOBS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215910) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02157500) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2025-02-28 |