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NPI Code Detail

MEDICARE: JAMES MICHAEL MCCULLOCK CMT

MEDICARE: JAMES MICHAEL MCCULLOCK CMT
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 Therapist88704CA

General Provider Information

NPI Number : 1598407819
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MICHAEL MCCULLOCK CMT
Provider Business Mailing Address
First Line : 4494 39TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-4677
Country : US
Telephone Number : 619-902-2591
Fax Number :
Provider Business Practice Location Address
First Line : 4494 39TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92116-4677
Country : US
Telephone Number : 619-902-2591
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2022
Last Update Date : 04/07/2022

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Directions to “ JAMES MICHAEL MCCULLOCK CMT” Practice Location

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