Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3297 | NH |
NPI | 1003567934 |
---|---|
Provider Name | Shirl Gene Ross |
First Address | Seabrook, NH 03874-4621 |
Second Address | Greenland, NH 03840-6235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2022 |
Last Update Date | 12/01/2022 |