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General NPI Number Information
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NPI Number | 1518859859
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Entity Type | Individual
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Provider Name | SAVOEUN PROK MASSAGE THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 8807 THORNTON RD
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City | STOCKTON
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State | CA
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Zip | 95209-1864
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Country | US
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Telephone | 209-629-5005
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 HAMLET CT
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City | STOCKTON
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State | CA
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Zip | 95209-1954
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Country | US
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Telephone | 209-629-5005
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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 | 99454
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License Number State | CA
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