| NPI | 1619563863 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 0017354) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 15240-24) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |