| NPI | 1720425549 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: VA 2305212941) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012174) |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2020-01-02 |