Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT009847 | GA |
NPI | 1013374446 |
---|---|
Provider Name | Beth Shannon |
First Address | Atlanta, GA 30308-1910 |
Second Address | Atlanta, GA 30308-1910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 14/01/2016 |