Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501008019 | MI |
NPI | 1003298498 |
---|---|
Provider Name | Alesha Kay Flynn |
First Address | Traverse City, MI 49696-8355 |
Second Address | Traverse City, MI 49684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 23/06/2015 |