Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | MASSAGE THERAPIST | PA |
Y | 225700000X | Massage Therapist | MSG4609 | PA |
NPI | 1194907113 |
---|---|
Provider Name | Carolyn Hubert-Black |
First Address | Philadelphia, PA 19115-1030 |
Second Address | Philadelphia, PA 19115-1030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2007 |
Last Update Date | 03/05/2015 |