| NPI | 1528299906 |
|---|---|
| Former Name | AUDREY MARIE LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MO 2009022187) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2018-03-15 |