Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 4818-146 | WI |
NPI | 1003422569 |
---|---|
Provider Name | Ms. Reeyanana Salet Cha |
First Address | Brookfield, WI 53005-3845 |
Second Address | Wauwatosa, WI 53222-3102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2020 |
Last Update Date | 21/09/2020 |