| NPI | 1659996585 |
|---|---|
| Former Name | SUELLEN CAROLINE MARQUES JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: MO 2020014754) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |