Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | M04724 | MD |
NPI | 1003233594 |
---|---|
Provider Name | Holly N Flynn |
First Address | Bel Air, MD 21015-6185 |
Second Address | Bel Air, MD 21015-6185 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2014 |
Last Update Date | 24/03/2014 |