| NPI | 1609832823 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4654-024) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 166-039) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |