Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA7331 | WA |
NPI | 1003949942 |
---|---|
Provider Name | Susan D Angelou |
First Address | Monroe, WA 98272 |
Second Address | Monroe, WA 98272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |