| NPI | 1528087442 |
|---|---|
| Former Name | JEANETTE MARIE BRANDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11903-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 008334) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 1315-39) | |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: OH 001071) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2017-03-01 |