| NPI | 1972970366 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209814) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL3192) |
| 225100000X Physical Therapist (Licence: DC PT871883) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2025-09-15 |