| NPI | 1538322490 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 1400-019) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WI 100-039) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2009-11-10 |