| NPI | 1619460789 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043672-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043672) |
| 225200000X Physical Therapy Assistant (Licence: TX 2137016) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-03-06 |