| NPI | 1568666980 |
|---|---|
| Former Name | AMANDA L MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008014942) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MO 2008014941) |
| 225100000X Physical Therapist (Licence: IA 004070) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2014-05-20 |