| NPI | 1396462032 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1307528) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012116-01) |
| Enumeration Date | 2022-10-24 |
| Last Update Date | 2023-11-15 |