| NPI | 1972791440 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 5714) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |