Individual
DONALD DEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
502 RETRIEVER CT, STATESBORO, GA 30461-4498
(912) 541-0589
Mailing address
502 RETRIEVER CT, STATESBORO, GA 30461-4498
(912) 541-0589
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
012315
GA
Other
Enumeration date
11/13/2018
Last updated
11/13/2018
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