| NPI | 1639334105 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29831) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 21275) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2015-01-14 |