| NPI | 1679357784 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501304140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16524-24) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2025-10-02 |