Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT010494 | GA |
NPI | 1013566058 |
---|---|
Provider Name | Dana C Gunter |
First Address | Duluth, GA 30096-8706 |
Second Address | Duluth, GA 30096-8706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2019 |
Last Update Date | 11/09/2019 |