MEDICARE: DANA WHITNEY CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	83214	CA

General Provider Information

NPI Number	:	1073185443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA WHITNEY CMT

Provider Business Mailing Address
First Line	:	4118 TEXAS ST APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1651
Country	:	US
Telephone Number	:	949-742-0522
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 TEXAS ST APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-1651
Country	:	US
Telephone Number	:	949-742-0522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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