| NPI | 1679169007 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16163) | 
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ LPT-31514) | 
| 225100000X Physical Therapist (Licence: IL 070.025479) | |
| Enumeration Date | 2020-12-20 | 
| Last Update Date | 2023-05-25 |