Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT134657 | TX |
NPI | 1013506682 |
---|---|
Provider Name | Mr. Jules Gordon Cumberbatch |
First Address | San Antonio, TX 78252-1715 |
Second Address | San Antonio, TX 78252-1715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2021 |
Last Update Date | 18/01/2021 |