| NPI | 1548801798 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: WV 004205) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MD 27690) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2021-03-28 |