| NPI | 1659922300 |
|---|---|
| Former Name | KATELYN ELIZABETH SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2019037873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06305) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2019-10-02 |