| NPI | 1922756006 |
|---|---|
| Former Name | NICOLE LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210051) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126003079) |
| Enumeration Date | 2022-03-16 |
| Last Update Date | 2022-03-16 |