| NPI | 1578312138 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004910) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WV AT001773) |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2025-08-14 |