Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 133071 | TX |
NPI | 1003569708 |
---|---|
Provider Name | Renee Jordan |
First Address | Katy, TX 77450-2076 |
Second Address | Katy, TX 77450-2076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2022 |
Last Update Date | 02/02/2022 |