| NPI | 1508847591 |
|---|---|
| Former Name | DIANNE ELLEN DAVIDSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305 000587) |
| Additional Taxonomies | 225000000X Orthotic Fitter |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2007-07-09 |