| NPI | 1679960728 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1266257) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011760) |
| Enumeration Date | 2015-04-15 |
| Last Update Date | 2017-04-03 |