| NPI | 1548815632 |
|---|---|
| Former Name | MACY JOHANNSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017497) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT298351) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-12-18 |