Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA41181 | FL |
NPI | 1003015058 |
---|---|
Provider Name | Leann C Elmore |
First Address | Vero Beach, FL 32965-0124 |
Second Address | Sebastian, FL 32958-7556 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 29/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C3752 | BLUE CROSS & BLUE SHIELD (01) | FL |