Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSG000797 | PA |
NPI | 1003170663 |
---|---|
Provider Name | Nicole Sechrist |
First Address | Kreamer, PA 17833-0123 |
Second Address | Kreamer, PA 17833-0123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2012 |
Last Update Date | 28/06/2012 |