| NPI | 1790267391 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63574) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1296976) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2020-05-29 |