| NPI | 1861071763 |
|---|---|
| Former Name | JEANETTA FRICKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215322) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029084) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-12-10 |