| NPI | 1770567620 |
|---|---|
| Former Name | PATRICIA LODGE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT38010) |
| 225100000X Physical Therapist (Licence: CA 24904) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2022-09-06 |