Healthcare Provider Details

I. General information

NPI: 1225551443
Provider Name (Legal Business Name): STRESSAGE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 UNIVERSITY AVE
LA MESA CA
91942-9323
US

IV. Provider business mailing address

8300 UNIVERSITY AVE
LA MESA CA
91942-9323
US

V. Phone/Fax

Practice location:
  • Phone: 619-622-1963
  • Fax:
Mailing address:
  • Phone: 619-622-1963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEREMY ALEXANDER HICKS
Title or Position: SPORTS REHABILITATION THERAPIST
Credential: CMT
Phone: 619-519-3632