| NPI | 1619360666 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 4630) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0003690) | 
| Enumeration Date | 2015-03-16 | 
| Last Update Date | 2024-08-23 |