| NPI | 1952414906 |
|---|---|
| Former Name | TINA LOUISE HEYDENBURG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL Pt 16749) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9844) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2013-03-05 |