Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 82116 | FL |
NPI | 1003357021 |
---|---|
Provider Name | Lucia Gwyn-Williams |
First Address | Gainesville, FL 32635-7279 |
Second Address | Gainesville, FL 32607-2817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |