| NPI | 1780960948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 9955-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017438) |
| 225100000X Physical Therapist (Licence: MN 7067) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: WI 969-39) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MN 2085) | |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2018-03-21 |