Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501001938 | MI |
NPI | 1003334533 |
---|---|
Provider Name | Leslie Estell |
First Address | Detroit, MI 48235-2539 |
Second Address | Detroit, MI 48219-2759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2017 |
Last Update Date | 05/09/2017 |