Healthcare Provider Details

I. General information

NPI: 1043945942
Provider Name (Legal Business Name): MADELINE CLARE BORN CMT, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 07/24/2022
Certification Date: 07/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 VALENCIA ST
SAN FRANCISCO CA
94103-2318
US

IV. Provider business mailing address

255 SHRADER ST APT 3
SAN FRANCISCO CA
94117-1874
US

V. Phone/Fax

Practice location:
  • Phone: 415-675-8973
  • Fax:
Mailing address:
  • Phone: 415-971-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number81348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: