Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 10256-146 | WI |
NPI | 1003439134 |
---|---|
Provider Name | Roberto Lorenzana |
First Address | Milwaukee, WI 53215-3813 |
Second Address | Milwaukee, WI 53207-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2020 |
Last Update Date | 23/05/2020 |