A licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Pediatric Physical Therapy, who has demonstrated specialized knowledge and skill in anatomy, histology, including embryonic development, genetics, biomechanics, neurological function, neuroscience, and pathology, behavioral sciences, and understanding of diseases or conditions that necessitate physical therapy care, that affect systems that in turn necessitate physical therapy care (comorbidities), and that influence the type of intervention that can be given.
| Specialty | Taxonomy Code | |
|---|---|---|
| * | Pediatrics | 2251P0200X |
| Orthopedic | 2251X0800X | |
| Physical Therapist | 225100000X |
* Indicates primary specialty
| NPI Number | 1356820989 |
| Credentials | PT (Physical Therapist) |
| Entity | Individual |
| Enumeration date | 08/14/2018 |
| Last updated | 01/12/2026 - About 5 months ago |
| Sole proprietor1 | No |
| Identifiers |
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| Hospital affiliation | n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.
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