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General NPI Number Information
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NPI Number | 1457073900
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Entity Type | Organization
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Legal Business Name | CLINICAL MASSAGE SERVICES LLC
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 5044 WOODMINSTER LN
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City | OAKLAND
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State | CA
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Zip | 94602-2614
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Country | US
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Telephone | 510-919-4852
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 7TH ST # 23971
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City | OAKLAND
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State | CA
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Zip | 94615-0002
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Country | US
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Telephone | 510-919-4852
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PHILLIP JOSEPH JR.
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Credential | CMT
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Telephone | 510-919-4852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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