Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA94301 | FL |
NPI | 1013661024 |
---|---|
Provider Name | A U |
First Address | Marietta, GA 30067-5320 |
Second Address | Alpharetta, GA 30009-3816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2022 |
Last Update Date | 08/02/2022 |