| NPI | 1538143938 |
|---|---|
| Former Name | JASMINE GUSTAFSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4663) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2015-04-07 |