| NPI | 1811027618 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 0400002721) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: VT 1040000002) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-06-14 |