| NPI | 1790198240 |
|---|---|
| Former Name | MELISSA MIRANDA WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 18468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 7393) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2020-01-08 |