Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT045436 | TX |
NPI | 1003155250 |
---|---|
Provider Name | Victoria Leigh Gommel |
First Address | Horseshoe Bay, TX 78657-5981 |
Second Address | Marble Falls, TX 78654-5757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2013 |
Last Update Date | 07/02/2013 |