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General NPI Number Information
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NPI Number | 1366000861
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Entity Type | Organization
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Legal Business Name | COMPLETE BODY WELLNESS
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 02/02/2020
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Provider Practice Location Address
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Address Line | 340 I ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4143
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Country | US
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Telephone | 209-658-1778
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Fax |
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Provider Business Mailing Address
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Address Line | 340 I ST
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City | LOS BANOS
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State | CA
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Zip | 93635-4143
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Country | US
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Telephone | 209-210-2116
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTON ESLINGER
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Credential | LMT, PTA
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Telephone | 209-658-1778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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