| NPI | 1558907410 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11732R) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: LA 339412) |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2024-03-18 |