Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 02267 | RI |
NPI | 1013379437 |
---|---|
Provider Name | Johannah Macbeth |
First Address | Providence, RI 02906-5210 |
Second Address | Providence, RI 02906-5210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 24/03/2016 |