| NPI | 1538567938 |
|---|---|
| Former Name | TRACY LYNN MOSHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2015002291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501011028) |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2018-06-30 |