| NPI | 1952750283 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134084) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VT 104.0121577) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2019-05-30 |