| NPI | 1417939893 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16330) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2019-09-04 |