| NPI | 1659499978 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11681-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 24192) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IA 00616) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2019-05-20 |