| NPI | 1780109124 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 5120) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2021-05-14 |