| NPI | 1902133531 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020476) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 029228-1) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2018-10-15 |