| NPI | 1871064956 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT011466) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: GA BOC153612) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2018-12-16 |