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General NPI Number Information
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NPI Number | 1295556595
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Entity Type | Individual
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Provider Name | JONATHAN EMANUEL MOSLEY MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 8920 EMERALD PARK DR STE C
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City | ELK GROVE
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State | CA
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Zip | 95624-2380
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Country | US
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Telephone | 916-685-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 ETHAN WAY
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City | SACRAMENTO
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State | CA
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Zip | 95825-0907
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Country | US
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Telephone | 916-877-0300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 96309
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License Number State | CA
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