Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6239 | NC |
NPI | 1003397027 |
---|---|
Provider Name | Gina Brannagan |
First Address | Waxhaw, NC 28173-1038 |
Second Address | Waxhaw, NC 28173-9020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |