Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA46565 | FL |
NPI | 1003018581 |
---|---|
Provider Name | Mayumi Moreira |
First Address | Tampa, FL 33618-2435 |
Second Address | Tampa, FL 33618-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 29/10/2012 |