Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0019009158 | VA |
NPI | 1003113440 |
---|---|
Provider Name | Mrs. Cybil S. Louie |
First Address | Herndon, VA 20172-0544 |
Second Address | Fairfax, VA 22031-4645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2011 |
Last Update Date | 22/02/2011 |