| NPI | 1467680835 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 8324399-8016) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 01997) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 8324399-4810) | |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2018-12-08 |