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General NPI Number Information
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NPI Number | 1679939094
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Entity Type | Individual
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Provider Name | TALITHA EKAMA CMTPT, ANMT, LMT
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Gender | Female
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 115 W 6TH ST SUITE 116
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City | TEMPE
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State | AZ
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Zip | 85281-3715
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Country | US
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Telephone | 323-686-2668
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Fax |
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Provider Business Mailing Address
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Address Line | 5104 E VAN BUREN ST APT 1151
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City | PHOENIX
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State | AZ
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Zip | 85008-7013
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Country | US
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Telephone |
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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 | 20660
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 42549
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License Number State | CA
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