| NPI | 1770123101 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14610) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: OH 14610-24) |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2021-05-24 |