| NPI | 1780065177 |
|---|---|
| Former Name | MARY SUELLENTROP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-05780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015016732) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-01-26 |