Individual
LISA NICOLE MCENTIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.M.T
Contact information
Practice address
119 FAIRVIEW OAK TRACE, DALLAS, GA 30157
(706) 853-1787
Mailing address
119 FAIRVIEW OAK TRACE, DALLAS, GA 30157
(706) 853-1787
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT004159
GA
Other
Enumeration date
10/12/2011
Last updated
10/12/2011
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