| NPI | 1770548620 |
|---|---|
| Former Name | CAROL LYNNE FENTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT007446L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT00115) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-10-12 |