| NPI | 1770874588 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WV 2001-1648) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WV 001522) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2015-10-23 |