Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA60203925 | WA |
NPI | 1013213644 |
---|---|
Provider Name | Patrick Antonio Brown |
First Address | Tacoma, WA 98444-4580 |
Second Address | Tacoma, WA 98444-4580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2011 |
Last Update Date | 29/01/2011 |