Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT112477 | TX |
NPI | 1003579616 |
---|---|
Provider Name | Jewel Jones |
First Address | Buda, TX 78610-0811 |
Second Address | Buda, TX 78610-4829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2021 |
Last Update Date | 20/10/2021 |