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General NPI Number Information
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NPI Number | 1306691449
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Entity Type | Individual
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Provider Name | SANTISOUK PROUGH CMT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2024
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 8278 W LAKE PLEASANT PKWY
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City | PEORIA
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State | AZ
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Zip | 85382-7441
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Country | US
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Telephone | 510-384-5817
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Fax |
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Provider Business Mailing Address
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Address Line | 19401 N 15TH PL
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City | PHOENIX
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State | AZ
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Zip | 85024-3625
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Country | US
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Telephone | 510-384-5817
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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 | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | MT
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License Number State | AZ
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