Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA31793 | FL |
NPI | 1013336270 |
---|---|
Provider Name | David Ward |
First Address | Tampa, FL 33626-1331 |
Second Address | Tampa, FL 33626-1331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2014 |
Last Update Date | 15/04/2014 |