Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT000565 | GA |
NPI | 1003096355 |
---|---|
Provider Name | Arnold Louis Peluso |
First Address | Smyrna, GA 30082-2201 |
Second Address | Smyrna, GA 30082-2201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2007 |
Last Update Date | 04/11/2007 |