Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003307984 |
---|---|
Provider Name | Becky Lee Snyder |
First Address | Isanti, MN 55040-6813 |
Second Address | Isanti, MN 55040-6813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |