MEDICARE: SAN LUIS CHRONIC PAIN MASSAGE THERAPY

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
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1548102619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN LUIS CHRONIC PAIN MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	78 ENCANTO LN
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7710
Country	:	US
Telephone Number	:	805-316-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 ZACA LN # 140
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-7300
Country	:	US
Telephone Number	:	805-316-5118
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EVA MALAMA
Credential	:	CMT
Telephone Number	:	805-316-5118

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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Directions to “SAN LUIS CHRONIC PAIN MASSAGE THERAPY ” Practice Location

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