NPI | 1982648242 |
---|---|
Former Name | TRACY MARIE BALDICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: IL 070.015461) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 18501) |
Enumeration Date | 2006-06-16 |
Last Update Date | 2024-03-18 |