Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6126 | MI |
NPI | 1013209758 |
---|---|
Provider Name | Kari Beth De St Germain |
First Address | Rockford, MI 49341-1266 |
Second Address | Rockford, MI 49341-1266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2011 |
Last Update Date | 28/02/2012 |