Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 80841 | FL |
NPI | 1013452598 |
---|---|
Provider Name | Jose Morales |
First Address | Sunrise, FL 33322-1403 |
Second Address | Sunrise, FL 33322-1403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 20/12/2016 |