Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501006903 | MI |
NPI | 1013376375 |
---|---|
Provider Name | Cynthia Salo |
First Address | Canton, MI 48187-3124 |
Second Address | Canton, MI 48187-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2016 |
Last Update Date | 15/02/2016 |