| NPI | 1689962540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT002723) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: TX 1148826) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: TX AT1055) | |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2011-07-13 |