Individual
PHYLLIS ROSE HAWKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
207 VAN BUREN DR, RAEFORD, NC 28376-9418
(910) 479-4306
Mailing address
207 VAN BUREN DR, RAEFORD, NC 28376-9418
(910) 479-4306
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14015
NC
Other
Enumeration date
04/18/2018
Last updated
04/18/2018
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