Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Aug 29, 2018
License(s)
1077030 (TX)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 9416 LAKE CT | Irving, TX 75063-5059 | |
| LOCATION | 2101 W NORTHGATE DR | Irving, TX 75062-2650 | 972-255-4460 |
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