Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0019013498 | VA |
NPI | 1013425008 |
---|---|
Provider Name | Miranda Hale |
First Address | Richmond, VA 23221-2200 |
Second Address | Richmond, VA 23221-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2018 |
Last Update Date | 12/01/2018 |