| NPI | 1831306117 |
|---|---|
| Former Name | SHANNA L PEDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-03699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2005019715) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-01-28 |