| NPI | 1861017808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE MARIE JACKSON VICENTE Owner 937-623-0689 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Additional Taxonomies | 172M00000X Mechanotherapist |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2020-06-16 |