| NPI | 1538189758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 00015) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IA 00658) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |