| NPI | 1972914299 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23957) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2016-03-01 |