Healthcare Provider Details

I. General information

NPI: 1336716646
Provider Name (Legal Business Name): NEUROMUSCULAR TRANSFORMATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2021
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 SANTA MONICA AVE UNIT 7840
SAN DIEGO CA
92107-2810
US

IV. Provider business mailing address

4833 SANTA MONICA AVE UNIT 7840
SAN DIEGO CA
92107-2810
US

V. Phone/Fax

Practice location:
  • Phone: 760-401-7968
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: DENNIS YOUNG
Title or Position: OWNER
Credential: MMT
Phone: 760-401-7968