Healthcare Provider Details

I. General information

NPI: 1710601562
Provider Name (Legal Business Name): BRYCE TAYLOR CARSKADON CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 SIERRA MADRE AVE
CLOVIS CA
93611-5085
US

IV. Provider business mailing address

2946 SIERRA MADRE AVE
CLOVIS CA
93611-5085
US

V. Phone/Fax

Practice location:
  • Phone: 559-347-7003
  • Fax:
Mailing address:
  • Phone: 559-347-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number88362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: