| NPI | 1699142828 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209527) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: VA 2305209527) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2021-06-11 |