| NPI | 1770152423 |
|---|---|
| Former Name | AMANDA ROSE VANOUDHEUSDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: AZ 14379) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OR 9955) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2023-02-17 |