Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 11553 | MA |
NPI | 1003473547 |
---|---|
Provider Name | Ana Gabriela Rosa |
First Address | Leominster, MA 01453 |
Second Address | Leominster, MA 01453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2019 |
Last Update Date | 21/05/2019 |