Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT101345 | TX |
NPI | 1003136094 |
---|---|
Provider Name | Anethia Cristal Love |
First Address | Houston, TX 77268-2983 |
Second Address | Houston, TX 77088-3231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 02/06/2010 |