Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA72227 | FL |
NPI | 1003430265 |
---|---|
Provider Name | Carolyn Mcdaniel |
First Address | Brandon, FL 33511-7405 |
Second Address | Brandon, FL 33511-7405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2020 |
Last Update Date | 03/06/2020 |