| NPI | 1568669398 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1458) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 297-05) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2010-09-14 |