Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 46725 | FL |
NPI | 1013412667 |
---|---|
Provider Name | Jennifer Fogel-Wartel |
First Address | Sunrise, FL 33351-7018 |
Second Address | Davie, FL 33328-3321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2018 |
Last Update Date | 27/03/2018 |