Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003463340 |
---|---|
Provider Name | Marcia Mae Mentele |
First Address | Sioux Falls, SD 57106-3511 |
Second Address | Sioux Falls, SD 57106-3511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2019 |
Last Update Date | 21/08/2019 |