| NPI | 1821646936 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT297364) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 0438999) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA PT297364) | |
| Enumeration Date | 2019-09-01 |
| Last Update Date | 2019-09-20 |