NPI | 1982867743 |
---|---|
Former Name | JENNIFER LOREN SELF |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6224) |
Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: AL 6224) |
Enumeration Date | 2008-07-02 |
Last Update Date | 2022-07-22 |