Individual
TOSHIBA FORREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3700 BRAMBLEVINE CIR, LITHONIA, GA 30038-2918
(770) 596-4896
Mailing address
4453 GROVE LAKE ST, LOGANVILLE, GA 30052-8144
(770) 596-4896
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT012062
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MT012062
—
GA
Enumeration date
05/18/2018
Last updated
08/28/2020
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