| NPI | 1619419579 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: TX 1277735) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX 1277735) |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2016-11-09 |