Individual
MYA I WENZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4223 PROVIDENCE RD STE B, CHARLOTTE, NC 28211-4457
(704) 769-7000
Mailing address
13119 GREAT LAUREL RD, CHARLOTTE, NC 28227-3689
(850) 316-7920
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
21296
NC
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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