NPI | 1477806230 |
---|---|
Former Name | ADRIENNE LEE BALOS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27845) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: GA PT010912) |
Enumeration Date | 2012-10-18 |
Last Update Date | 2021-10-05 |