| NPI | 1609128453 |
|---|---|
| Former Name | MYRA GUDEMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009756) |
| Additional Taxonomies | 171W00000X Contractor (Licence: WA PT00009756) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2017-03-30 |