Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT09144 | AZ |
NPI | 1013416841 |
---|---|
Provider Name | Gwendolyn Abrahamson |
First Address | Fort Collins, CO 80527-3326 |
Second Address | Mesa, AZ 85215-2821 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 07/02/2018 |