Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT21505558 | IN |
NPI | 1013554625 |
---|---|
Provider Name | Rebecca Marie Townsend |
First Address | Indianapolis, IN 46260-4421 |
Second Address | Indianapolis, IN 46202-4328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2019 |
Last Update Date | 02/12/2019 |