| NPI | 1588785349 |
|---|---|
| Former Name | MARY ELIZABETH BAUDENDISTEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1057099) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 01519) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2011-10-19 |