| NPI | 1720056351 |
|---|---|
| Former Name | ANTONETTE LEE MADER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OH PT006830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1117968) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2010-03-23 |