Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 028028 | NY |
NPI | 1003415431 |
---|---|
Provider Name | Jessica Lynn Narus |
First Address | East Moriches, NY 11940-1201 |
Second Address | Bohemia, NY 11716-1045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 08/12/2020 |