| NPI | 1871938852 |
|---|---|
| Former Name | CARLY MATICHAK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 020439) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2015-12-11 |