Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT104843 | TX |
NPI | 1003365685 |
---|---|
Provider Name | Maria Ortiz |
First Address | Houston, TX 77018-8114 |
Second Address | Houston, TX 77018-8114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2016 |
Last Update Date | 24/09/2016 |