| NPI | 1902870629 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 5632) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NH 0251) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA 305) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |