Individual
JACQUELINE SUE DIDUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
6960 MARKET ST, 8, YOUNGSTOWN, OH 44512-4559
(330) 758-8060
(330) 758-8060
Mailing address
6960 MARKET ST, 8, YOUNGSTOWN, OH 44512-4559
(330) 758-8060
(330) 758-8060
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
33.011438
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611416126-00
EIN
OH
Enumeration date
01/27/2016
Last updated
01/27/2016
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