Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0019006891 | VA |
NPI | 1013100650 |
---|---|
Provider Name | Christie Dawn Sullivan |
First Address | Fredericksburg, VA 22407-6327 |
Second Address | Spotsylvania, VA 22553-1798 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 27/08/2007 |