Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT109063 | TX |
N | 226300000X | Kinesiotherapist |
NPI | 1679930283 |
---|---|
Provider Name | Patricia Sifuentes |
First Address | Yukon, OK 73099-4471 |
Second Address | Yukon, OK 73099-4471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2016 |
Last Update Date | 05/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
810815010 | LICENSED MASSAGE THERAPIST (01) | OK |
MT109063 | LISENCED MASSAGE THERAPIST (01) | TX |