Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | AK |
NPI | 1003295155 |
---|---|
Provider Name | Suzanne Webb |
First Address | Ketchikan, AK 99901-8944 |
Second Address | Ketchikan, AK 99901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2015 |
Last Update Date | 09/06/2018 |