| NPI | 1912614686 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WI 2260) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WI 15749) |
| Enumeration Date | 2022-11-02 |
| Last Update Date | 2022-11-02 |