Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0125811 | NY |
NPI | 1013132174 |
---|---|
Provider Name | Mr. Jonathan Albert White |
First Address | Elmira, NY 14901 |
Second Address | Elmira, NY 14901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |