Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 18372 | NC |
Y | 225700000X | Massage Therapist | MA86700 | FL |
NPI | 1013661453 |
---|---|
Provider Name | Ann Marie Fowler-Pyle |
First Address | Panama City, FL 32405-1527 |
Second Address | Lynn Haven, FL 32444-3240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2022 |
Last Update Date | 04/02/2022 |