| NPI | 1477089498 |
|---|---|
| Former Name | SHELBY MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501018166) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT015505) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2021-11-30 |