Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6104 | FL |
NPI | 1023197381 |
---|---|
Provider Name | Cathy Ann Lee |
First Address | Brandenton, FL 34202 |
Second Address | Brandenton, FL 34202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |