Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT127494 | TX |
NPI | 1013572585 |
---|---|
Provider Name | Amber Robinson |
First Address | Bay City, TX 77414 |
Second Address | Bay City, TX 77414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2019 |
Last Update Date | 11/06/2019 |