| NPI | 1629349642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 3547) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0003720) |
| 225700000X Massage Therapist (Licence: MA 1663) | |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |