Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 00363 | GA |
NPI | 1013230341 |
---|---|
Provider Name | Ardell Buckey Knight |
First Address | Brunswick, GA 31525-7933 |
Second Address | Brunswick, GA 31525-7933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2010 |
Last Update Date | 01/03/2010 |