| NPI | 1760036800 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 24605) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC LAT-5317) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NJ 25MT00347700) | |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2026-03-04 |