| NPI | 1467807255 |
|---|---|
| Former Name | AMANDA GRACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH9210) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039971) |
| Enumeration Date | 2016-04-28 |
| Last Update Date | 2022-10-18 |