| NPI | 1689187064 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24980) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 3058) | |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2021-04-12 |