| NPI | 1790295772 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4154) |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2018-03-17 |