Individual
BRIAN GWALTNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CMT
Contact information
Practice address
305 C ST APT B, ROSEVILLE, CA 95678-3170
(907) 764-9014
Mailing address
305 C ST APT B, ROSEVILLE, CA 95678-3170
(907) 764-9014
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
50701
CA
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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