| NPI | 1629467600 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MA 1165) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 725) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2015-01-14 |