| NPI | 1679607675 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MS PT4511) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 1665) |
| 225100000X Physical Therapist (Licence: LA 07464R) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-08-31 |