Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 582258 | MI |
NPI | 1003202912 |
---|---|
Provider Name | Elizabeth Madell |
First Address | Petoskey, MI 49770-8515 |
Second Address | Petoskey, MI 49770-8515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2015 |
Last Update Date | 04/08/2021 |