| NPI | 1700175072 |
|---|---|
| Former Name | MARILYN ELIZABETH VAN DE BOGART |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: FL PTA000333) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |