Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2005-1691 | WV |
NPI | 1003304015 |
---|---|
Provider Name | Julie Beth Wilson Shinaberry |
First Address | Morgantown, WV 26507-0404 |
Second Address | Morgantown, WV 26505-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2018 |
Last Update Date | 16/12/2020 |