| NPI | 1649684234 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT015661) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA AT002641) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR AT 593) | |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2023-01-30 |