| NPI | 1790903284 |
|---|---|
| Former Name | SUSAN THERESE BALKUN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: RI PT00157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 1602) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |