NPI | 1639437619 |
---|---|
Former Name | JAYECE R. OLSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 767) |
Additional Taxonomies | 174400000X Specialist (Licence: AZ 9001) |
Enumeration Date | 2012-04-27 |
Last Update Date | 2013-02-20 |