Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33.022691 | OH |
NPI | 1003275116 |
---|---|
Provider Name | Adriana Urista |
First Address | South Lebanon, OH 45065-0210 |
Second Address | South Lebanon, OH 45065-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 17/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000000 | NONE (01) | OH |