NPI | 1821656950 |
---|---|
Former Name | AMANDA ILLA PICKWORTH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501303770) |
Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: MI 5502003904) |
Enumeration Date | 2019-06-04 |
Last Update Date | 2025-02-05 |