NPI | 1508917758 |
---|---|
Former Name | NADINE ROSE QUEEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT10558) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL PT10558) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL383) | |
Enumeration Date | 2007-01-15 |
Last Update Date | 2022-10-14 |