Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003141904 |
---|---|
Provider Name | Krista Marie Beerman |
First Address | Fulda, MN 56131-1275 |
Second Address | Fulda, MN 56131-9401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2009 |
Last Update Date | 09/10/2009 |