Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013329994 |
---|---|
Provider Name | Sara Clark |
First Address | Redding, CA 96003-4036 |
Second Address | Redding, CA 96003-4036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 27/05/2014 |