| NPI | 1770075293 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0015264) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: CO AT.0001755) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CO AT.0001755) | |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2020-11-11 |