Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA 45385 | FL |
NPI | 1013041573 |
---|---|
Provider Name | Ms. Rishona King |
First Address | Tampa, FL 33684-5779 |
Second Address | Tampa, FL 33614-7163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA 45385 | STATE LICENSE (01) | FL |