Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003191578 |
---|---|
Provider Name | Gina Booth |
First Address | Cleveland, OH 44105-1313 |
Second Address | Cleveland, OH 44105-1313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2011 |
Last Update Date | 17/10/2011 |