Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT020074 | TX |
NPI | 1003272303 |
---|---|
Provider Name | Angela Buchanan |
First Address | Rockwall, TX 75087-2419 |
Second Address | Rockwall, TX 75087-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2016 |
Last Update Date | 04/01/2016 |