| NPI | 1750909206 |
|---|---|
| Former Name | MADELINE SUZANNE SIMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 298500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13836-24) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2020-07-17 |