| NPI | 1407537657 |
|---|---|
| Former Name | JANIS KATHLEEN DAVENPORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA32927) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MD A4223) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2023-07-31 |