| NPI | 1912151093 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 008695-1) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 008695-1) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NJ 40QA00445400) | |
| Enumeration Date | 2008-11-16 |
| Last Update Date | 2009-01-09 |