| NPI | 1710698584 |
|---|---|
| Former Name | MICHELLE MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61606693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 37453) |
| Enumeration Date | 2022-12-12 |
| Last Update Date | 2024-10-30 |