Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | NVMT.6404 | NV |
NPI | 1003356833 |
---|---|
Provider Name | Tina Yaeger |
First Address | Las Vegas, NV 89103-8218 |
Second Address | Las Vegas, NV 89103-8218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 27/02/2017 |