NPI | 1467066563 |
---|---|
Former Name | CAROLINE AMANDA MALONE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT014934) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT014934) |
Enumeration Date | 2020-09-04 |
Last Update Date | 2023-02-06 |