| NPI | 1518367358 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MS AT0500) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MS PTA-7032) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2022-08-12 |