Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA79714 | FL |
NPI | 1013514462 |
---|---|
Provider Name | Sylvia Michelle Burch |
First Address | Orlando, FL 32806-2416 |
Second Address | Orlando, FL 32806-2416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 07/10/2020 |