Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013009737 |
---|---|
Provider Name | Jennifer C Hicks |
First Address | Great Falls, MT 59405-4406 |
Second Address | Great Falls, MT 59405-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |