Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 60452 | CA |
NPI | 1003202102 |
---|---|
Provider Name | Jody Taylor |
First Address | Murrieta, CA 92563-7269 |
Second Address | Murrieta, CA 92562-4010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 15/04/2015 |