Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 023714 | OH |
NPI | 1013484708 |
---|---|
Provider Name | Terrence Jones |
First Address | Dayton, OH 45417-3445 |
Second Address | Dayton, OH 45417-3445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 11/06/2019 |