| NPI | 1831503200 |
|---|---|
| Former Name | JENNIFER HAGEDORN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0012308) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0012308) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2018-08-10 |