Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 029294 | NY |
NPI | 1003419995 |
---|---|
Provider Name | Crystal Feliciano |
First Address | Brooklyn, NY 11221-3116 |
Second Address | Brooklyn, NY 11221-3116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2020 |
Last Update Date | 21/11/2020 |