| NPI | 1568707396 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2086896) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NM A-0875) |
| 225200000X Physical Therapy Assistant (Licence: CO PTA.0012931) | |
| 225200000X Physical Therapy Assistant (Licence: NE 1154) | |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2012-12-05 |