Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 4716-146 | WI |
NPI | 1003392366 |
---|---|
Provider Name | William Flaherty Hayes |
First Address | Madison, WI 53717-2156 |
Second Address | Madison, WI 53717-2156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2018 |
Last Update Date | 19/07/2018 |