| NPI | 1578861001 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 8084) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MA 8084) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 8084) | |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2011-03-08 |