Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013575216 |
---|---|
Provider Name | Madeline Mccarthy |
First Address | Gunnison, CO 81230-2201 |
Second Address | Gunnison, CO 81230-2208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2019 |
Last Update Date | 03/06/2019 |