| NPI | 1679106629 |
|---|---|
| Former Name | HEATHER JEAN THEISS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME PT5506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038947-01) |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2020-02-20 |