| NPI | 1922467802 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4558) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: WV 2000005401) |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2016-02-19 |