Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6931 | CO |
NPI | 1013212786 |
---|---|
Provider Name | Filipinas Sagario Simpson |
First Address | Pueblo, CO 81003-3119 |
Second Address | Pueblo, CO 81003-3119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2011 |
Last Update Date | 11/01/2011 |