Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 011013 | NY |
NPI | 1003865528 |
---|---|
Provider Name | Ms. Mary Jane Toepfer |
First Address | Fairport, NY 14450-1601 |
Second Address | Fairport, NY 14450-3407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175937GG | PREFERRED CARE (01) | NY |