| NPI | 1639501059 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05011220A) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: IN MT21103924) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 36001922A) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2022-07-21 |