Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 970243 | AK |
NPI | 1003176736 |
---|---|
Provider Name | Mary Andrews |
First Address | Anchorage, AK 99504 |
Second Address | Anchorage, AK 99504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 29/05/2012 |