Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3322-46 | WI |
NPI | 1003141748 |
---|---|
Provider Name | Tonya L Christoph |
First Address | Green Bay, WI 54313-2801 |
Second Address | Green Bay, WI 54313-2801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2009 |
Last Update Date | 14/10/2009 |