Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA94155 | FL |
NPI | 1013520139 |
---|---|
Provider Name | Joseph Fielder |
First Address | Winter Park, FL 32792-2517 |
Second Address | Winter Park, FL 32792-2517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2020 |
Last Update Date | 28/08/2020 |