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NPI Code Detail

MEDICARE: CARISA CHREE KING MASSAGE THERAPIST

MEDICARE: CARISA CHREE KING MASSAGE THERAPIST
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 TherapistMT011526GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1052887721OTHERGAMASSAGE THERAPIST

General Provider Information

NPI Number : 1487256731
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARISA CHREE KING MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 2141 KINGSTON CT SE STE 111
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8928
Country : US
Telephone Number : 470-999-0392
Fax Number :
Provider Business Practice Location Address
First Line : 2141 KINGSTON CT SE STE 111
Second Line :
City : MARIETTA
State : GA
Zip : 30067-8928
Country : US
Telephone Number : 470-999-0392
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/11/2020
Last Update Date : 11/11/2020

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Directions to “ CARISA CHREE KING MASSAGE THERAPIST” Practice Location

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