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NPI Code Detail

MEDICARE: EFFIE HARDY CMT, CLT

MEDICARE: EFFIE HARDY CMT, CLT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist39185CA

General Provider Information

NPI Number : 1447995394
Entity Type Code : Individual
Provider Name (Legal Business Name) : EFFIE HARDY CMT, CLT
Provider Business Mailing Address
First Line : 2616 PACIFIC AVE UNIT 4825
Second Line :
City : STOCKTON
State : CA
Zip : 95204-7026
Country : US
Telephone Number : 209-279-6322
Fax Number :
Provider Business Practice Location Address
First Line : 2009 PACIFIC AVE
Second Line :
City : STOCKTON
State : CA
Zip : 95204-5327
Country : US
Telephone Number : 209-279-6322
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2022
Last Update Date : 05/04/2022

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Directions to “ EFFIE HARDY CMT, CLT” Practice Location

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