Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA24914 | FL |
NPI | 1003823659 |
---|---|
Provider Name | Diane Chapman |
First Address | Oakland Park, FL 33309-3923 |
Second Address | Oakland Park, FL 33309-3923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |