| NPI | 1649978909 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-8516) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: 2000052814) | |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-07-19 |