Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA31066 | FL |
NPI | 1013187475 |
---|---|
Provider Name | Mr. Andrew Watts Williams JR. |
First Address | Gulf Breeze, FL 32561-4727 |
Second Address | Gulf Breeze, FL 32561-4727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2008 |
Last Update Date | 03/03/2008 |