Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 556 | NV |
NPI | 1003253501 |
---|---|
Provider Name | Jenny Marie Raety |
First Address | Las Vegas, NV 89103-7046 |
Second Address | Las Vegas, NV 89103-7046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 24/05/2013 |