| NPI | 1407056567 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CO PTL-5317) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL-5317) |
| 171W00000X Contractor (Licence: CO AT.0000634) | |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2017-01-04 |