| NPI | 1710363833 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63609) | 
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006655) | 
| Enumeration Date | 2015-07-31 | 
| Last Update Date | 2025-07-29 |