| NPI | 1972143691 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24963) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: 070024802) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2021-06-04 |