Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 027897 | NY |
NPI | 1003453663 |
---|---|
Provider Name | Natasha Miller |
First Address | Elmont, NY 11003-4239 |
Second Address | Elmont, NY 11003-4239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2019 |
Last Update Date | 03/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
027897 | (05) | NY |