Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 12795 | NC |
NPI | 1013430339 |
---|---|
Provider Name | Tara Denise Lone |
First Address | Kernersville, NC 27284-3114 |
Second Address | Kernersville, NC 27284-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 18/07/2017 |