NPI | 1538451430 |
---|---|
Former Name | TINA MARIE LEAVENWORTH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225700000X Massage Therapist (Licence: OR 18135) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 18135) |
Enumeration Date | 2011-05-10 |
Last Update Date | 2020-12-10 |