NPI | 1811071939 |
---|---|
Former Name | AMY LYNN EGGLESTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501012925) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070016591) |
Enumeration Date | 2006-10-25 |
Last Update Date | 2022-07-21 |