Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT127038 | TX |
NPI | 1013408079 |
---|---|
Provider Name | Stephanie M Smith |
First Address | Pflugerville, TX 78660-2244 |
Second Address | Georgetown, TX 78628-1376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |