| NPI | 1396879748 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 027235) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 027235) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2021-08-16 |