| NPI | 1912764671 |
|---|---|
| Former Legal Business Name | N/A |
| Entity Type | Organization |
| Authorized Contact | PREVIOUS J WOODS Owner 662-303-4699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Enumeration Date | 2024-02-29 |
| Last Update Date | 2024-02-29 |