Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT042911 | TX |
NPI | 1013407592 |
---|---|
Provider Name | Frank Medina |
First Address | Quinlan, TX 75474-3437 |
Second Address | Quinlan, TX 75474-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 10/05/2018 |