Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MT010527 | TX |
NPI | 1003144916 |
---|---|
Provider Name | Wanda Nerene Holder |
First Address | Corsicana, TX 75110-4242 |
Second Address | Corsicana, TX 75110-6402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2009 |
Last Update Date | 17/05/2011 |