NPI | 1902468200 |
---|---|
Former Name | ASHLEY NICOLE PENNINGTON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5901) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3984) |
225100000X Physical Therapist (Licence: KS 11-06159) | |
Enumeration Date | 2019-07-08 |
Last Update Date | 2021-05-21 |