Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA97907 | FL |
NPI | 1013689223 |
---|---|
Provider Name | Natalie Elledge |
First Address | Delray Beach, FL 33444-1891 |
Second Address | Delray Beach, FL 33444-1891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2021 |
Last Update Date | 05/10/2021 |