| NPI | 1801259338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20582) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2017-06-14 |