Healthcare Provider Details

I. General information

NPI: 1730009846
Provider Name (Legal Business Name): JESSICA CANAGA MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 HOWELL RD STE 14
GREENVILLE SC
29615-2050
US

IV. Provider business mailing address

528 HOWELL RD STE 14
GREENVILLE SC
29615-2050
US

V. Phone/Fax

Practice location:
  • Phone: 864-451-2482
  • Fax:
Mailing address:
  • Phone: 864-451-2482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13706
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: