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General NPI Number Information
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NPI Number | 1366216350
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Entity Type | Individual
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Provider Name | KELLY MARIE DARGIE LMT
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Gender | Female
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 3104 S DEL RANCHO
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City | MESA
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State | AZ
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Zip | 85212-1889
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Country | US
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Telephone | 480-415-8532
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50191
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City | MESA
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State | AZ
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Zip | 85208-0010
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Country | US
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Telephone | 480-415-8532
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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 | MT-2023-0153
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License Number State | NM
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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 | MT-26671
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License Number State | AZ
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