| NPI | 1942679642 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21859) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2018-09-25 |