Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 128017 | TX |
NPI | 1003392200 |
---|---|
Provider Name | Lyniettra Woods |
First Address | Houston, TX 77065-3127 |
Second Address | Houston, TX 77070-4534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |