MEDICARE: LARA SITA HORNBECK CMT, CST-T

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	CAMTC83572	CA

General Provider Information

NPI Number	:	1982561049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA SITA HORNBECK CMT, CST-T

Provider Business Mailing Address
First Line	:	2421 4TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2430
Country	:	US
Telephone Number	:	510-325-2724
Fax Number	:

Provider Business Practice Location Address
First Line	:	2421 4TH ST
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94710-2430
Country	:	US
Telephone Number	:	510-325-2724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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