Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT002619 | GA |
NPI | 1013155936 |
---|---|
Provider Name | Geraldine Newman |
First Address | Brunswick, GA 31525-3059 |
Second Address | Brunswick, GA 31525-3059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 17/07/2009 |