| NPI | 1780992149 |
|---|---|
| Former Name | STEPHANIE MICHELLE SANDOVAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: TX 2078550) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH 06405) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-09-20 |