| NPI | 1396769956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 0400003585) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104-0000111) |
| 225100000X Physical Therapist (Licence: NY 62-022037) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 000798-1) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-04-10 |