Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA51691 | FL |
NPI | 1013106392 |
---|---|
Provider Name | Mrs. Jessyca M Hogan |
First Address | Ormond Beach, FL 32174-3853 |
Second Address | Ormond Beach, FL 32174-3853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 23/10/2007 |