| NPI | 1619356409 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0012409) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MN 9902) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA PT41184) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-12-07 |