| NPI | 1760406078 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA at001616) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12499) |
| 225100000X Physical Therapist (Licence: GA PT013778) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NC 1019) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-09-19 |