| NPI | 1609024843 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6158) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005774) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AL 1009) | |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2019-03-29 |