| NPI | 1902279011 |
|---|---|
| Former Name | JESSIKA MCCLUNE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 130306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 61026) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2020-07-16 |