| NPI | 1811187461 |
|---|---|
| Former Name | ANNA R WYKSTRA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11045026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2371 (temp license)) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2008-07-17 |