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General NPI Number Information
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NPI Number | 1396522033
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Entity Type | Individual
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Provider Name | WILLY RAY FLEMING JR. CMT
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Gender | Male
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Dates
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Enumeration Date | 09/14/2023
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 1801 HANOVER DR STE D
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City | DAVIS
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State | CA
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Zip | 95616-1067
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Country | US
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Telephone | 530-400-6533
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Fax |
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Provider Business Mailing Address
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Address Line | 167 QUINCY CT
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City | VACAVILLE
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State | CA
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Zip | 95687-6733
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Country | US
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Telephone | 904-254-5047
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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 | 74497
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License Number State | CA
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