Individual
BONITA HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
7916 MANDREL WAY, RALEIGH, NC 27616-9503
(919) 522-5882
Mailing address
7916 MANDREL WAY, RALEIGH, NC 27616-9503
(919) 522-5882
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
04956
NC
Other
Enumeration date
09/10/2020
Last updated
09/10/2020
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