| NPI | 1962122143 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1340458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 36656) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2022-11-22 |