| NPI | 1659660355 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 0400104540) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0075936) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2014-08-25 |