| NPI | 1689125338 |
|---|---|
| Former Name | SAMANTHA WIELENGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2021-07-14 |