MEDICARE: GUTHRIE BRIDGE 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	92494	CA

General Provider Information

NPI Number	:	1457122962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUTHRIE BRIDGE CMT

Provider Business Mailing Address
First Line	:	PO BOX 811
Second Line	:
City	:	GUERNEVILLE
State	:	CA
Zip	:	95446-0811
Country	:	US
Telephone Number	:	631-742-7929
Fax Number	:

Provider Business Practice Location Address
First Line	:	2635 CLEVELAND AVE STE 3
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2981
Country	:	US
Telephone Number	:	707-239-9224
Fax Number	:

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

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	01/12/2024

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