Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 14456 | WI |
NPI | 1013422641 |
---|---|
Provider Name | Virginia F Pawlak |
First Address | Alma, WI 54610-7712 |
Second Address | Alma, WI 54610-7712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 05/12/2017 |