Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT3140 | TN |
NPI | 1003115171 |
---|---|
Provider Name | Mrs. Petra Doris Price |
First Address | Chattanooga, TN 37421 |
Second Address | Chattanooga, TN 37421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2011 |
Last Update Date | 15/03/2011 |