| NPI | 1134588288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL R WAGNER Secretary 920-968-0464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WI 13327-146) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2024-06-11 |