| NPI | 1780894733 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MO 111893) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: MO 2001025951) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-05-01 |