Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | VA |
NPI | 1003455841 |
---|---|
Provider Name | Mr. Ryan Greene |
First Address | Richmond, VA 23220-4629 |
Second Address | Richmond, VA 23220-4629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2019 |
Last Update Date | 26/12/2019 |