Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA57626 | FL |
NPI | 1013314855 |
---|---|
Provider Name | Edward Halleran |
First Address | Safety Harbor, FL 34695-4014 |
Second Address | Safety Harbor, FL 34695-4014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2014 |
Last Update Date | 21/11/2014 |