| NPI | 1932677804 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0017381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12073) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: CT 1069) | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2021-01-13 |