Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | ||
N | 226300000X | Kinesiotherapist |
NPI | 1619211919 |
---|---|
Provider Name | Daketia L Thomas |
First Address | Kalamazoo, MI 49005 |
Second Address | Kalamazoo, MI 49002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2012 |
Last Update Date | 27/11/2012 |