| NPI | 1619311255 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011147L) |
| 225100000X Physical Therapist (Licence: SC .8777) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2018-10-10 |