| NPI | 1992764716 |
|---|---|
| Former Name | JENNIFER LYNN NICOLLA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 34072) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023503-1) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2016-08-01 |