| NPI | 1851327258 |
|---|---|
| Former Name | MARY GRACE CAPUNO FONDEVILLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01021100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01021100) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2007-07-08 |