| NPI | 1508828450 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13019) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: SC 764) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-01-29 |