| NPI | 1902159932 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26654) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207616) |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2023-04-04 |