Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0019001948 | VA |
NPI | 1003974312 |
---|---|
Provider Name | Ms. Amy Elizabeth Mckay |
First Address | Reston, VA 20195-2284 |
Second Address | Reston, VA 20190-4987 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |