Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 017463-1 | NY |
NPI | 1003061730 |
---|---|
Provider Name | Ann J Rouse |
First Address | Pittsford, NY 14534-2866 |
Second Address | Pittsford, NY 14534-2866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2008 |
Last Update Date | 21/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175979GG | PREFERRED CARE (01) | NY |