Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 155516-00 | FL |
NPI | 1003107343 |
---|---|
Provider Name | Diane Benfield |
First Address | Coeur D Alene, ID 83814-4903 |
Second Address | Coeur D Alene, ID 83814-4903 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2011 |
Last Update Date | 20/04/2011 |