| NPI | 1497482962 |
|---|---|
| Former Name | SUMMER ROSE THIBODEAU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-026637) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2026-04-14 |