| NPI | 1659753077 |
|---|---|
| Former Name | JENNA ALLYCE WEIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015027244) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2019-03-06 |