Individual
REBECCA LYNNE WENTWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7050 JIMMY CARTER BLVD, NORCROSS, GA 30092-3257
(770) 364-1857
Mailing address
5443 OLIVER CT NW, LILBURN, GA 30047-5822
(770) 364-1857
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
BR009324
GA
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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