Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA81743 | FL |
NPI | 1003431529 |
---|---|
Provider Name | Martha Malmberg |
First Address | Palm Coast, FL 32137-8853 |
Second Address | Palm Coast, FL 32137-4777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 10/06/2020 |