| NPI | 1790275121 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 037-839) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 037839) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 037-839) | |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2021-11-15 |