| NPI | 1902340722 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62223) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OR 62223) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: OR 62223) | |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: OR 62223) | |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2022-05-28 |