| NPI | 1770128290 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: TX MT107484) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TX MT107484) |
| 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: TX MT107484) | |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2019-11-07 |