| NPI | 1760565634 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 887) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 422) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ND 089-91) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-09 |