| NPI | 1619529195 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22692) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027666) |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-25 |