Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT003848 | GA |
NPI | 1003161902 |
---|---|
Provider Name | Mr. Norman Michael Teal |
First Address | Decatur, GA 30033-2606 |
Second Address | Atlanta, GA 30327-2135 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 17/07/2012 |