Individual
MISS CATHY YVONNE WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT019073
Contact information
Practice address
1109 EVERGREEN ST, LONGVIEW, TX 75604-2130
(903) 736-2969
Mailing address
100 OWENS RD LOT 506, WHITE OAK, TX 75693
(903) 736-2969
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT019073
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MT019073
MASSAGE THERAPIST
TX
Enumeration date
05/01/2009
Last updated
05/01/2009
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