| NPI | 1407203920 |
|---|---|
| Former Name | MIRACLE ASHLEY-ANNGELLE ANDERSON-DOUGLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31362) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT014961) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2024-02-15 |