| NPI | 1942083480 |
|---|---|
| Former Name | JESSICA LYNN MADDOX |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-33153) |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-30 |