| NPI | 1457740243 |
|---|---|
| Former Name | AMBER DYAN BLODGETTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MO 2016013016) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 66 009768) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2017-02-08 |