| NPI | 1942625512 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2316) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist Athletic Trainer (Licence: SD 0408) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2021-07-25 |