Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 74816 | CA |
NPI | 1013495548 |
---|---|
Provider Name | Cheryl Stone |
First Address | Windsor, CA 95492-9780 |
Second Address | Windsor, CA 95492-9549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2018 |
Last Update Date | 06/08/2018 |