Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10028 | NC |
NPI | 1003373481 |
---|---|
Provider Name | Ms. Andralee Mahealani Soller |
First Address | Charlotte, NC 28203-4780 |
Second Address | Charlotte, NC 28203-4780 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2019 |
Last Update Date | 21/02/2019 |