Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 84328 | CA |
NPI | 1013597590 |
---|---|
Provider Name | Julius Lee Copeland JR. |
First Address | Clovis, CA 93612-4715 |
Second Address | Clovis, CA 93612-4715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2021 |
Last Update Date | 09/04/2021 |