Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG010906 | PA |
NPI | 1013464841 |
---|---|
Provider Name | Miss Aubree Nicole Kurtz |
First Address | Lititz, PA 17543-8907 |
Second Address | Lititz, PA 17543-8907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |