Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1455-146 | WI |
NPI | 1003443557 |
---|---|
Provider Name | Andrea Lynn Dinauer |
First Address | Milwaukee, WI 53233-1308 |
Second Address | Milwaukee, WI 53233-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 25/03/2020 |