| NPI | 1518035658 |
|---|---|
| Former Name | MOLLY MARIE BRUNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 011743) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1139509) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2024-06-13 |