| NPI | 1902854797 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 28563) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 2251S0007X Physical Therapist, Sports (Licence: FL PT 28563) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-09-23 |