Individual
AUTUMN COMPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
623 E FLORENCE BLVD STE A, CASA GRANDE, AZ 85122-4153
(520) 635-5585
Mailing address
623 E FLORENCE BLVD STE A, CASA GRANDE, AZ 85122-4153
(520) 635-5585
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT24021
AZ
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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