Individual
HERA KNIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
597 MAIN ST, SOUTH PORTLAND, ME 04106-5412
(207) 774-7242
Mailing address
597 MAIN ST, SOUTH PORTLAND, ME 04106-5412
(207) 774-7242
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT2199
ME
Other
Enumeration date
07/10/2010
Last updated
07/10/2010
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