NPI | 1457655235 |
---|---|
Former Name | KATRINA SUE WENGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT009626L) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT001661) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT001500A) | |
Enumeration Date | 2011-01-07 |
Last Update Date | 2020-05-11 |