| NPI | 1629693601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 10613) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: LA 10613) |
| Enumeration Date | 2020-06-15 |
| Last Update Date | 2024-01-31 |