Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT-15361 | AZ |
NPI | 1013270750 |
---|---|
Provider Name | Ryanna Colleen Sharp |
First Address | Payson, AZ 85541-6192 |
Second Address | Scottsdale, AZ 85255-7819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 18/06/2012 |