| NPI | 1598807562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 1046) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 11155) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AZ 0199) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |