| NPI | 1700435732 |
|---|---|
| Former Name | RENEE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 11666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16261) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2023-08-23 |