Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1000319834121 | MT |
NPI | 1003040437 |
---|---|
Provider Name | Miss Tiara Z Liberty |
First Address | Missoula, MT 59801 |
Second Address | Missoula, MT 59801-5601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 13/05/2009 |