| NPI | 1508808023 |
|---|---|
| Former Name | MICHELLE GERDOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21462) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J100001445) |
| 225100000X Physical Therapist (Licence: PA PT013241L) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2019-06-03 |