| NPI | 1710192703 |
|---|---|
| Former Name | SANDRA MARIE LEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05000547A) |
| 225100000X Physical Therapist (Licence: MO R0055) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |