| NPI | 1710984455 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2500) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: HI 2500) |
| 2251S0007X Physical Therapist Sports (Licence: HI 2500) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: HI 2500) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |