NPI | 1558606764 |
---|---|
Former Name | SHANYN D FIALKOV |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0013752) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20186) |
Enumeration Date | 2012-11-29 |
Last Update Date | 2022-07-21 |