| NPI | 1578055364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-04-10 |