| NPI | 1962747808 |
|---|---|
| Former Name | DANA JANE GERVAIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 9153) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2021-04-12 |