Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 020058 | NY |
NPI | 1003162504 |
---|---|
Provider Name | Lynette Rodgers |
First Address | Rochester, NY 14623-2805 |
Second Address | Rochester, NY 14623-2805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2012 |
Last Update Date | 02/08/2012 |