Individual
MRS. PENELOPE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2322 HIGHWAY 43 S, SUITE A, PICAYUNE, MS 39466-7525
(601) 799-4118
Mailing address
52 MORRIS SONES RD, PICAYUNE, MS 39466-6627
(601) 862-0670
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
811
MS
Other
Enumeration date
08/11/2010
Last updated
08/11/2010
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