Individual
BILL DEAN ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
3116 OTIS AV, MODESTO, CA 95350
(209) 567-1432
Mailing address
3116 OTIS AV, MODESTO, CA 95350
(209) 567-1432
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
08/29/2012
Last updated
08/29/2012
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