Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013106137 |
---|---|
Provider Name | Sarah Elaine Gibson |
First Address | Fridley, MN 55432-4656 |
Second Address | Fridley, MN 55432-4656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 15/10/2007 |