Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 19019 | NC |
NPI | 1013586411 |
---|---|
Provider Name | Bethany A Butler |
First Address | Kannapolis, NC 28083-6579 |
Second Address | Charlotte, NC 28212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |