Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT6151 | ME |
NPI | 1013558634 |
---|---|
Provider Name | Monica P Gunning |
First Address | Bangor, ME 04401-5947 |
Second Address | Bangor, ME 04401-5947 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 04/10/2019 |