| NPI | 1992790257 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 15115) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: FL 15115) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL 15115) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL 1084) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2007-07-08 |