Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 029153 | NY |
NPI | 1013379247 |
---|---|
Provider Name | Kathryn Broeker |
First Address | Niagara Falls, NY 14302-0373 |
Second Address | Niagara Falls, NY 14301-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2016 |
Last Update Date | 26/03/2016 |