Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6944 | TN |
NPI | 1013182054 |
---|---|
Provider Name | Pauline Diaz-Borg |
First Address | Portland, TN 37148-3601 |
Second Address | Murfreesboro, TN 37129-2791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 30/04/2008 |