| NPI | 1932415254 |
|---|---|
| Former Name | WENDY BACON-FULKERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT3169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60387980) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2022-07-21 |