Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 26BT00206100 | NJ |
NPI | 1013230127 |
---|---|
Provider Name | Janelle Diana King |
First Address | Wyckoff, NJ 07481-5200 |
Second Address | Wyckoff, NJ 07481-5200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2010 |
Last Update Date | 03/03/2010 |