Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003420662 |
---|---|
Provider Name | Tina Marie Casey |
First Address | Dover, DE 19904-3860 |
Second Address | Dover, DE 19904-3860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000000000000 | DELAWARE (01) | DE |
00000000000000000 | (05) | DE |