| NPI | 1710314109 |
|---|---|
| Former Name | JESSICA LYNN MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10556) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8459588-2401) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2018-03-17 |