Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 447 | MA |
NPI | 1003132531 |
---|---|
Provider Name | Evan Featherstone |
First Address | Newton, MA 02465-2001 |
Second Address | Newton, MA 02465-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2010 |
Last Update Date | 08/04/2010 |