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General NPI Number Information
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NPI Number | 1497648638
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Entity Type | Organization
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Legal Business Name | MYOTHERAPY BODYWORK AND REHABILITATION
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1910 S ARCHIBALD AVE STE D
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City | ONTARIO
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State | CA
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Zip | 91761-8503
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Country | US
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Telephone | 909-569-3913
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Fax |
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Provider Business Mailing Address
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Address Line | 11783 BRANDYWINE PL
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3915
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Country | US
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Telephone | 909-569-3913
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Fax |
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | JOEL DACANAY
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Credential | LMT
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Telephone | 909-569-3913
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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 |
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License Number State |
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