Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA55571 | FL |
NPI | 1003442583 |
---|---|
Provider Name | Mrs. Ashley Hendrickson |
First Address | Dade City, FL 33523-7057 |
Second Address | Dade City, FL 33523-7057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 17/03/2020 |