Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013149327 |
---|---|
Provider Name | Athena Christine Farmer |
First Address | San Bernardino, CA 92401 |
Second Address | San Bernardino, CA 92401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 20/08/2009 |