| NPI | 1790861847 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT007822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5092) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2012-03-12 |