| NPI | 1508514654 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1358540) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: TX 1358540) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-07-28 |