| NPI | 1740242619 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 01806R) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: TX 1079085) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |