| NPI | 1639767718 |
|---|---|
| Former Name | DESIREE LYNN FREDERICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 12097) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2024-07-08 |