Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-02454P | AZ |
NPI | 1003120536 |
---|---|
Provider Name | Forrest Ann Walsh |
First Address | Tempe, AZ 85283-2101 |
Second Address | Tempe, AZ 85283-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |