Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA62767 | FL |
NPI | 1013201730 |
---|---|
Provider Name | Mr. Billy Jacob Estes |
First Address | Palm Bay, FL 32907-8204 |
Second Address | Palm Bay, FL 32907-8204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |