Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT02364 | RI |
NPI | 1013453331 |
---|---|
Provider Name | Emmanuel Avellanet |
First Address | Providence, RI 02906-5210 |
Second Address | Providence, RI 02906-5210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2017 |
Last Update Date | 10/01/2017 |