| NPI | 1548560691 |
|---|---|
| Former Name | MARY KATHERINE OLYVIA CAMPBELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6652) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL PT25937) |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2012-10-23 |