Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA21938 | FL |
NPI | 1003989823 |
---|---|
Provider Name | Julia M Stapleton |
First Address | Panama City, FL 32401-3979 |
Second Address | Panama City, FL 32401-3979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C7423 | BLUE CROSS PROVIDER (01) | FL |