Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 107473 | TX |
NPI | 1013453125 |
---|---|
Provider Name | Brittni J Bowen |
First Address | Plano, TX 75023-7315 |
Second Address | Dallas, TX 75208-6231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2017 |
Last Update Date | 12/01/2017 |