Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 19656 | OR |
NPI | 1013552025 |
---|---|
Provider Name | Miss Dina Rose |
First Address | Eugene, OR 97401-2221 |
Second Address | Eugene, OR 97401-2221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |