| NPI | 1861007718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2026023735) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: IN 07222074000014) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2026-07-15 |