Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 101920 | AK |
NPI | 1013441674 |
---|---|
Provider Name | Micaela Bauer |
First Address | Juneau, AK 99801-1312 |
Second Address | Juneau, AK 99801-1853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 20/04/2017 |