Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA35745 | FL |
NPI | 1003127911 |
---|---|
Provider Name | Susan D Meagher |
First Address | Inverness, FL 34453-1448 |
Second Address | Hernando, FL 34442-4552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C2448 | BCBSFL (01) | FL |