Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT21906969 | IN |
NPI | 1013552835 |
---|---|
Provider Name | Heidi Moring |
First Address | Fort Wayne, IN 46804-6826 |
Second Address | Fort Wayne, IN 46804-6826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2019 |
Last Update Date | 17/02/2020 |