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NPI Code Detail

MEDICARE: TABITHA HERSEY MT

MEDICARE: TABITHA HERSEY MT
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1437773686
Entity Type Code : Individual
Provider Name (Legal Business Name) : TABITHA HERSEY MT
Provider Business Mailing Address
First Line : 945 N OAKLAND AVE
Second Line :
City : PASADENA
State : CA
Zip : 91104-3631
Country : US
Telephone Number : 626-241-4541
Fax Number :
Provider Business Practice Location Address
First Line : 3460 OCEAN VIEW BLVD STE B
Second Line :
City : GLENDALE
State : CA
Zip : 91208-3306
Country : US
Telephone Number : 626-241-4541
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2020
Last Update Date : 06/03/2020

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Directions to “ TABITHA HERSEY MT” Practice Location

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