Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225700000X | Massage Therapist |
NPI | 1013133826 |
---|---|
Provider Name | Vitia Angela Pack |
First Address | Miami, FL 33126-2051 |
Second Address | Weston, FL 33326-2395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA31540 | LICENSE NUMBER (01) | FL |