| NPI | 1407499684 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63974) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01855100) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2021-02-03 |