| NPI | 1831309632 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT002647) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT004111) |
| 225100000X Physical Therapist (Licence: PA PT018962) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2014-10-08 |