Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | LMBT1302 | NC |
NPI | 1003582909 |
---|---|
Provider Name | Mihwa K Allen |
First Address | Fayetteville, NC 28301-5573 |
Second Address | Fayetteville, NC 28301-5573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2021 |
Last Update Date | 19/08/2021 |