| NPI | 1508245051 |
|---|---|
| Former Name | JESSICA ELISABETHER BOLSTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032362) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3979) |
| 225100000X Physical Therapist (Licence: PA DAPT006162) | |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2024-10-23 |