Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | MT006953 | GA |
N | 225XE1200X | Ergonomics | MT006953 | GA |
N | 225400000X | Rehabilitation Practitioner | MT006953 | GA |
Y | 225700000X | Massage Therapist | MT006953 | GA |
NPI | 1679866131 |
---|---|
Provider Name | Ana Maria Vidarte |
First Address | Snellville, GA 30078-4549 |
Second Address | Alpharetta, GA 30022-1837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 17/05/2011 |