NPI | 1427255405 |
---|---|
Former Name | SHELLA JOHNSTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 23052) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14164) |
Enumeration Date | 2007-07-02 |
Last Update Date | 2019-05-13 |