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General NPI Number Information
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NPI Number | 1437323276
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Entity Type | Individual
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Provider Name | WILMA RUTH PRINCE LMT
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Gender | Female
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 566 BELL RD
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City | ANTIOCH
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State | TN
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Zip | 37013
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Country | US
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Telephone | 615-365-7810
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Fax | 615-467-6671
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | ANTIOCH
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State | TN
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Zip | 37011-0488
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Country | US
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Telephone | 615-365-7810
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Fax | 615-467-6671
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0978
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License Number State | TN
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