Healthcare Provider Details

I. General information

NPI: 1720337132
Provider Name (Legal Business Name): KIM LAURIE SCOTT HHP-MASSAGE THERAPIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SAXONY ROAD ATT: BLOOMING TOUCH
ENCINITAS CA
92024
US

IV. Provider business mailing address

335 SAXONY ROAD ATT: BLOOMING TOUCH
ENCINITAS CA
92024
US

V. Phone/Fax

Practice location:
  • Phone: 760-672-7546
  • Fax: 760-632-5300
Mailing address:
  • Phone: 760-672-7546
  • Fax: 760-632-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number16271
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: