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 |