| NPI | 1912147893 |
|---|---|
| Former Name | JENNIFER LYNN WALLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA RT001482A) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-03-04 |