Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | 20953 | OR |
NPI | 1013375567 |
---|---|
Provider Name | Nicholas K Sweet |
First Address | Pocatello, ID 83209-7074 |
Second Address | Hillsboro, OR 97124-6448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2016 |
Last Update Date | 26/10/2021 |