| NPI | 1710969878 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MT 712PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 712PT) |
| 225000000X Orthotic Fitter (Licence: MT 712PT) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-08-20 |