Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013473735 |
---|---|
Provider Name | Sonja Rose-Parks |
First Address | Lafayette, OR 97127-9174 |
Second Address | Newberg, OR 97132-1856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2019 |
Last Update Date | 19/02/2019 |