| NPI | 1639648777 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0011629) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2021-10-19 |