Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1237 | NC |
NPI | 1003423880 |
---|---|
Provider Name | Amber Simerly Magliocca |
First Address | Jacksonville, NC 28540-4908 |
Second Address | Jacksonville, NC 28540-4759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 25/09/2020 |