| NPI | 1821638602 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 012678) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2020-01-09 |