Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist | ||
Y | 226300000X | Kinesiotherapist | 1060542 |
NPI | 1578106274 |
---|---|
Provider Name | Valentino Bailey |
First Address | Miami, FL 33136-2010 |
Second Address | Miami, FL 33136-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2019 |
Last Update Date | 25/10/2019 |