| NPI | 1669897799 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT 003137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT 022743) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2014-02-26 |