| NPI | 1710790571 |
|---|---|
| Former Name | JACLYN MICHELLE HERON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 20362) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-07-10 |