Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA82516 | FL |
NPI | 1013450311 |
---|---|
Provider Name | Ms. Dale Washington |
First Address | Miami Beach, FL 33140-4563 |
Second Address | Miami Beach, FL 33140-4563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2016 |
Last Update Date | 18/11/2016 |