Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 0028357 | NY |
NPI | 1013507763 |
---|---|
Provider Name | Ronisha Powell |
First Address | Saint Albans, NY 11412-4012 |
Second Address | Saint Albans, NY 11412-4012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2021 |
Last Update Date | 26/01/2021 |