Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA33060 | FL |
NPI | 1013249747 |
---|---|
Provider Name | Christopher Krause |
First Address | Sarasota, FL 34234 |
Second Address | University Park, FL 34201-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2010 |
Last Update Date | 05/02/2010 |