Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA25185 | FL |
NPI | 1003171588 |
---|---|
Provider Name | Ms. Cheryl M Thacker |
First Address | Atlantic Bch, FL 32233-1988 |
Second Address | Atlantic Beach, FL 32233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 10/07/2012 |