Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MT1541 | ME |
N | 225700000X | Massage Therapist | MT1541 | ME |
NPI | 1558905851 |
---|---|
Provider Name | Rose Rapp |
First Address | Belfast, ME 04915-7510 |
Second Address | Belfast, ME 04915-7510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 30/10/2019 |