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General NPI Number Information
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NPI Number | 1487004776
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Entity Type | Organization
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Legal Business Name | COACH KANDYE
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 225 30TH ST 303
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City | SACRAMENTO
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State | CA
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Zip | 95816-3359
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Country | US
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Telephone | 916-469-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 225 30TH ST 303
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City | SACRAMENTO
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State | CA
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Zip | 95816-3359
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Country | US
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Telephone | 916-469-5433
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Fax |
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Authorized Official
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Title or Position | CERTIFIED MASSAGE THERAPIST
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Name | MS. KAMELA ANNE HILL
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Credential | CMT
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Telephone | 916-469-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 37058
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License Number State | CA
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