Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | MA 62794 | FL |
Y | 226300000X | Kinesiotherapist | MT007988 | GA |
NPI | 1821385063 |
---|---|
Provider Name | Mr. Pierre Browne |
First Address | Marietta, GA 30067-8656 |
Second Address | Marrietta, GA 30067 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2011 |
Last Update Date | 08/05/2012 |