Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2857 | AL |
NPI | 1013235506 |
---|---|
Provider Name | Mrs. Lisa Diane Garrison |
First Address | Florence, AL 35630-2433 |
Second Address | Florence, AL 35630-2443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2010 |
Last Update Date | 10/05/2010 |