| NPI | 1629675871 |
|---|---|
| Former Name | LORIBETH RIDENOUR DOMINIQUE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WV WVPTA002672) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |