MEDICARE: JAYSON A RICKS LMT

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	11431	CA

General Provider Information

NPI Number	:	1285390633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSON A RICKS LMT

Provider Business Mailing Address
First Line	:	4228 PALMERO BLVD
Second Line	:
City	:	VIEW PARK
State	:	CA
Zip	:	90008-4422
Country	:	US
Telephone Number	:	323-216-7978
Fax Number	:

Provider Business Practice Location Address
First Line	:	8590 W SUNSET BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-2354
Country	:	US
Telephone Number	:	323-216-7978
Fax Number	:

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

Provider Enumeration Date	:	11/10/2021
Last Update Date	:	11/10/2021

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