| NPI | 1811442643 |
|---|---|
| Former Name | AMY PETERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225700000X Massage Therapist (Licence: WA MA60607989) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 22033) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2016-08-22 |