Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-11691 | AZ |
NPI | 1003300880 |
---|---|
Provider Name | Jodi Jones |
First Address | Prescott, AZ 86301-1164 |
Second Address | Prescott, AZ 86301-1164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 15/06/2018 |