Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003218454 |
---|---|
Provider Name | Michelle Lynn Warner |
First Address | Walnut Creek, CA 94598-2435 |
Second Address | Walnut Creek, CA 94598-2435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 17/09/2014 |