Individual
DE QIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4360 W THUNDERBIRD RD, GLENDALE, AZ 85306-5027
(480) 304-1964
Mailing address
4209 E WILLIAMS DR, PHOENIX, AZ 85050-8718
(480) 304-1964
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-27263
AZ
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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