Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16327 | NC |
NPI | 1013550771 |
---|---|
Provider Name | Mr. Mckinley Bernard Knight |
First Address | Smithfield, NC 27577-2962 |
Second Address | Smithfield, NC 27577-9495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2019 |
Last Update Date | 18/08/2021 |