| NPI | 1720646359 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40524) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA26257) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2023-08-31 |