| NPI | 1790259505 |
|---|---|
| Former Name | AMY LYNN GOVEDNIK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: MT PTP-PTA-LIC-13106) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: IL 160.008020) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-01-15 |