Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 024407 | NY |
NPI | 1013523042 |
---|---|
Provider Name | Thiace Ayesha Marie Norman |
First Address | Fishkill, NY 12524-1523 |
Second Address | Fishkill, NY 12524-1523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2020 |
Last Update Date | 15/09/2020 |