| NPI | 1639134273 |
|---|---|
| Former Name | CAROL SUE HAAKENSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 8079) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2008-07-16 |