Individual
MARY ROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 ATLEY ST, SOLDIERS GROVE, WI 54655-8505
(507) 571-0585
Mailing address
PO BOX 92, GAYS MILLS, WI 54631-0092
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
2436-146
WI
Other
Enumeration date
10/19/2022
Last updated
10/19/2022
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