| NPI | 1922526557 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10703) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: AL 2110) |
| Enumeration Date | 2017-09-04 |
| Last Update Date | 2022-06-15 |