Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT008905 | GA |
NPI | 1013327147 |
---|---|
Provider Name | Tonjyanikkia Wright |
First Address | Augusta, GA 30904-5221 |
Second Address | Augusta, GA 30906-5900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 21/02/2017 |