| NPI | 1699317420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210041) |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation (Licence: VA 2305210041) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: VA 2305210041) | |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2026-04-23 |