| NPI | 1417401159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 22499) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MA 22499) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2019-11-04 |