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General NPI Number Information
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NPI Number | 1316324197
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Entity Type | Organization
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Legal Business Name | INDIVIDUAL KNEADS
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 121 BERNAL RD (LOCATED INSIDE GOLD'S GYM)
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City | SAN JOSE
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State | CA
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Zip | 95119-1396
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Country | US
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Telephone | 408-656-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 7096 VIA PACIFICA
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City | SAN JOSE
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State | CA
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Zip | 95139-1147
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Country | US
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Telephone | 408-656-9200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LISA R SILVERS
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Credential | CMT
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Telephone | 408-656-9200
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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 | 611
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License Number State | CA
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