| NPI | 1699822783 |
|---|---|
| Former Name | SANDRA LUCILLE MCKINNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 11648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT 01187) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-11-25 |