| NPI | 1922313261 |
|---|---|
| Former Name | STEPHANIE SUZANNE BLACKBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6278PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032914-1) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2013-03-18 |