NPI | 1700446721 |
---|---|
Former Name | CARLY MICHELLE SLAGEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MO 2019031259) |
Additional Taxonomies | 225100000X Physical Therapist |
2251X0800X Physical Therapist Orthopedic (Licence: KS 11-06393) | |
Enumeration Date | 2019-06-20 |
Last Update Date | 2023-03-07 |