| NPI | 1831573336 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 30692) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MT ATR-LAT-LIC-1176) |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2020-07-29 |