Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 48744 | FL |
NPI | 1013482348 |
---|---|
Provider Name | Sharon Kelly |
First Address | Largo, FL 33770-3220 |
Second Address | Largo, FL 33770-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2018 |
Last Update Date | 13/10/2018 |