| NPI | 1801193248 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9524) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: WI 11563-024) |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2020-01-20 |