MEDICARE: STEPHANIE CORANN ESKEW 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	79463	CA

General Provider Information

NPI Number	:	1255181863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CORANN ESKEW CMT

Provider Business Mailing Address
First Line	:	690 N CASTLE ROCK ST SPC 17
Second Line	:
City	:	WOODLAKE
State	:	CA
Zip	:	93286-1144
Country	:	US
Telephone Number	:	559-280-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 N CASTLE ROCK ST SPC 17
Second Line	:
City	:	WOODLAKE
State	:	CA
Zip	:	93286-1144
Country	:	US
Telephone Number	:	805-253-3873
Fax Number	:

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

Provider Enumeration Date	:	03/26/2024
Last Update Date	:	03/26/2024

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Directions to “ STEPHANIE CORANN ESKEW CMT” Practice Location

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