Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003025487 |
---|---|
Provider Name | Mrs. Loretta J Komocar |
First Address | Margate, FL 33063-5022 |
Second Address | Oakland Park, FL 33334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |