| NPI | 1760995690 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.026635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042623) |
| 261QP2000X Clinic/Center Physical Therapy (Licence: NY 042623) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2022-08-29 |