| NPI | 1407071632 |
|---|---|
| Former Name | SUZANNE BASTOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 22799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007917) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2017-04-10 |