| NPI | 1407288244 |
|---|---|
| Former Name | JESSICA A WALDECKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.024936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1232320) |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2021-09-08 |