| NPI | 1518105352 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 12505) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WI 1374-019) |
| Enumeration Date | 2009-02-02 |
| Last Update Date | 2022-03-14 |