| NPI | 1871923649 |
|---|---|
| Former Name | NICOLE A MOKLESTAD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14798) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2015-11-17 |