| NPI | 1912174541 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV 000791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202126) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WV 000791) | |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |