| NPI | 1922544162 |
|---|---|
| Former Name | ANDREA MARIE VIVIAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 10946) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13391) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2022-02-24 |