Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA80881 | FL |
NPI | 1013464718 |
---|---|
Provider Name | Mark Freeman |
First Address | Miami, FL 33145-3282 |
Second Address | Miami, FL 33145-3282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |