Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 27021337 | NY |
NPI | 1013162205 |
---|---|
Provider Name | Mrs. Betsy Eaton |
First Address | Bronx, NY 10475-2302 |
Second Address | Bronx, NY 10475-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 01/12/2008 |