| NPI | 1578698254 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: PA PT-006121-L) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251P0200X Physical Therapist, Pediatrics | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2017-05-02 |