| NPI | 1588621783 |
|---|---|
| Former Name | STACY DITTMER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070-013906) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 080587) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2025-10-17 |