Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | ||
N | 175L00000X | Homeopath | ||
Y | 225700000X | Massage Therapist |
NPI | 1396190211 |
---|---|
Provider Name | Dwight Tinney |
First Address | Rockwall, TX 75087-4017 |
Second Address | Rockwall, TX 75087-4017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |