Healthcare Provider Details

I. General information

NPI: 1275474090
Provider Name (Legal Business Name): DESTINY RENEE WEBB I LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 N DYSART RD STE E
AVONDALE AZ
85323-1516
US

IV. Provider business mailing address

1327 N DYSART RD
AVONDALE AZ
85323-1537
US

V. Phone/Fax

Practice location:
  • Phone: 602-699-4434
  • Fax:
Mailing address:
  • Phone: 602-699-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number21016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: