Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 019539 | TX |
NPI | 1013551951 |
---|---|
Provider Name | Syreeta Mass |
First Address | Pantego, TX 76013-3404 |
Second Address | Pantego, TX 76013-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2019 |
Last Update Date | 04/11/2019 |