Individual
TIFFANY L POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
3245 PACKER DR # 103, RACINE, WI 53404-1151
(530) 414-8715
Mailing address
3245 PACKER DR # 103, RACINE, WI 53404-1151
(530) 414-8715
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14889-146
WI
Other
Enumeration date
03/27/2021
Last updated
03/27/2021
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