| NPI | 1790301976 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 32918) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 32918) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: FL 32918) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |