Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA41050 | FL |
NPI | 1013476795 |
---|---|
Provider Name | Tina Monroe |
First Address | Ocala, FL 34480-5288 |
Second Address | Ocala, FL 34474-6606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2019 |
Last Update Date | 13/03/2019 |