Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | BMTMTH00222477 | KY |
NPI | 1013375450 |
---|---|
Provider Name | Rhonda Fowler |
First Address | Frankfort, KY 40601-8403 |
Second Address | Frankfort, KY 40601-8403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2016 |
Last Update Date | 30/01/2016 |