| NPI | 1619030442 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60753) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MA00009970) |
| 225700000X Massage Therapist (Licence: OR 20447) | |
| 225100000X Physical Therapist (Licence: WA 60459440) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2016-10-06 |