| NPI | 1962130658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL26302) |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2025-07-25 |