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General NPI Number Information
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NPI Number | 1114515053
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Entity Type | Organization
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Legal Business Name | SHASTA STRONG MASSAGE AND WELLNESS
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 1083 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-2115
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Country | US
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Telephone | 530-605-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 1083 HARTNELL AVE
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City | REDDING
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State | CA
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Zip | 96002-2115
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Country | US
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Telephone | 530-605-0071
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Fax |
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Authorized Official
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Title or Position | OWNER/ CMT
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Name | JORDAN L VALENZUELA
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Credential | CMT
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Telephone | 530-605-0071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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