| NPI | 1871168005 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2024033758) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1388720) |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2025-08-04 |