Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT123106 | TX |
NPI | 1003328535 |
---|---|
Provider Name | Chris Craig |
First Address | Saginaw, TX 76179-1351 |
Second Address | Euless, TX 76039-3670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2017 |
Last Update Date | 24/10/2017 |