Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT001527 | GA |
NPI | 1013521939 |
---|---|
Provider Name | Chaun Walker |
First Address | Atlanta, GA 30318-7435 |
Second Address | Atlanta, GA 30318-7435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2020 |
Last Update Date | 08/09/2020 |