Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 006531 | IA |
NPI | 1003478249 |
---|---|
Provider Name | Sarah Boniface |
First Address | Marion, IA 52302-3833 |
Second Address | Marion, IA 52302-3833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 08/07/2019 |