Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 33006999 | OH |
NPI | 1023076585 |
---|---|
Provider Name | Rhonda S Crockett |
First Address | Columbus, OH 43218-3108 |
Second Address | Columbus, OH 43221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |