Healthcare Provider Details

I. General information

NPI: 1780520692
Provider Name (Legal Business Name): PATRICIA PAISLEY CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 IVY DR APT 14
OAKLAND CA
94606-2196
US

IV. Provider business mailing address

2609 IVY DR APT 14
OAKLAND CA
94606-2196
US

V. Phone/Fax

Practice location:
  • Phone: 510-575-1730
  • Fax:
Mailing address:
  • Phone: 510-575-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number64641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: