Healthcare Provider Details

I. General information

NPI: 1336485523
Provider Name (Legal Business Name): PSOAS MASSAGE AND BODYWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 3RD ST SUITE 205
SAN FRANCISCO CA
94107-1240
US

IV. Provider business mailing address

333 3RD ST SUITE 205
SAN FRANCISCO CA
94107-1240
US

V. Phone/Fax

Practice location:
  • Phone: 415-227-0331
  • Fax: 415-227-4308
Mailing address:
  • Phone: 415-227-0331
  • Fax: 415-227-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number000547
License Number StateCA

VIII. Authorized Official

Name: MRS. JENNIFER LYNN LIGHTSTONE
Title or Position: OWNER AND THERAPIST
Credential: CMT
Phone: 415-227-0331