Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA73768 | FL |
NPI | 1003297532 |
---|---|
Provider Name | Ms. Janice Kennard Wingate |
First Address | Gainesville, FL 32606-6632 |
Second Address | Gainesville, FL 32606-6632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2015 |
Last Update Date | 10/06/2015 |