Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 33049 | FL |
NPI | 1003115304 |
---|---|
Provider Name | Darlene Ann Kinzel |
First Address | Merritt Island, FL 32953-4616 |
Second Address | Merritt Island, FL 32953-4616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2011 |
Last Update Date | 25/03/2011 |