| NPI | 1962667964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN PT-6375) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12907-24) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2019-08-09 |