Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MSP2262 | TX |
NPI | 1003568023 |
---|---|
Provider Name | Regina R Hargrove |
First Address | Fort Worth, TX 76137-2979 |
Second Address | Fort Worth, TX 76137-2979 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |