| NPI | 1558398107 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 771AT) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 771) |
| 225700000X Massage Therapist (Licence: MA 7426) | |
| 225700000X Massage Therapist (Licence: MA 7426MT) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2015-03-31 |