Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT134683 | TX |
NPI | 1003497314 |
---|---|
Provider Name | Demarr Lowe Thomas |
First Address | Killeen, TX 76549-4904 |
Second Address | Belton, TX 76513-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2021 |
Last Update Date | 19/04/2021 |