| NPI | 1649683004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-7501) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-08-06 |