Healthcare Provider Details

I. General information

NPI: 1194593178
Provider Name (Legal Business Name): CHANTELLE COWAN CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35625 HIGHWAY 190 STE 201
SPRINGVILLE CA
93265-9747
US

IV. Provider business mailing address

PO BOX 270
SPRINGVILLE CA
93265-0270
US

V. Phone/Fax

Practice location:
  • Phone: 559-350-1998
  • Fax:
Mailing address:
  • Phone: 559-350-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number95167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: