Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 81854 | CA |
NPI | 1003405416 |
---|---|
Provider Name | Kristin Leigh Manon |
First Address | Chino, CA 91708-9300 |
Second Address | Chino, CA 91708-9300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2021 |
Last Update Date | 12/01/2021 |