Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | NY |
NPI | 1003106733 |
---|---|
Provider Name | Corina Zackowski |
First Address | Billings, MT 59102-0700 |
Second Address | Billings, MT 59102-0700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 14/04/2011 |